title: Balanitis xerotica obliterans in children and adolescents: a literature review and clinical series.
abstract: OBJECTIVE
  Balanitis xerotica obliterans (BXO) is a chronic inflammatory disease that is considered as male genital variant lichen sclerosis. The incidence varies greatly in different series; diagnosis is mostly clinical but histopathological confirmation is mandatory. Various treatments are described, but there is no consensus that one is the best.
  
  
  METHODS
  A literature review was made of BXO and lichen sclerosis in boys under 18 years of age, between 1995 and 2013, analyzing demographic dates, treatments and outcomes. In addition to that, we reviewed BXO cases treated in our centers in the last 10 years.
  
  
  RESULTS
  After literature review, only 13 articles matched the inclusion criteria. Analyzing those selected, the global incidence of BXO is nearly 35% among circumcised children. Described symptoms are diverse and the low index of clinical suspicion is highlighted. The main treatment is circumcision, with use of topical and intralesional steroids and immunosuppressive agents.
  
  
  CONCLUSIONS
  BXO is a condition more common than we believe and we must be vigilant to find greater number of diagnoses to avoid future complications. The main treatment for BXO is circumcision, but as topical or intralesional treatments are now available with potentially good outcomes, they may be considered as coadjuvants.
authors.affiliation: Pediatric Urology Service, Dr. Exequiel González Cortés Hospital, Santiago, Chile; School of Medicine, Department of Pediatrics and Pediatric Surgery, University of Chile, Santiago, Chile.
authors.forename: Soledad
authors.initials: S
authors.lastname: Celis
authors.affiliation: Pediatric Urology Service, Dr. Exequiel González Cortés Hospital, Santiago, Chile; Clínica Santa María, Santiago, Chile.
authors.forename: Francisco
authors.initials: F
authors.lastname: Reed
authors.affiliation: St Georges Hospital, London, UK.
authors.forename: Feilim
authors.initials: F
authors.lastname: Murphy
authors.affiliation: St Georges Hospital, London, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Adams
authors.affiliation: Temple Street University Hospital, Dublin, Ireland.
authors.forename: John
authors.initials: J
authors.lastname: Gillick
authors.affiliation: Temple Street University Hospital, Dublin, Ireland.
authors.forename: Abdelhafeez H
authors.initials: AH
authors.lastname: Abdelhafeez
authors.affiliation: Pediatric Urology Service, Dr. Exequiel González Cortés Hospital, Santiago, Chile; School of Medicine, Department of Pediatrics and Pediatric Surgery, University of Chile, Santiago, Chile; Clínica Alemana, Santiago, Chile. Electronic address: pejotalopez@yahoo.com.
authors.forename: Pedro-Jose
authors.initials: PJ
authors.lastname: Lopez
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D052798:Balanitis Xerotica Obliterans / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D002944:Circumcision, Male; D003131:Combined Modality Therapy; D004817:Epidermis / Q000473:pathology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies
chemical_list: D000305:Adrenal Cortex Hormones
keywords: Balanitis xerotica obliterans; Lichen sclerosus et atrophicus; Pediatric adolescents review treatment; Phimosis