CLINICAL QUESTION

Are topical corticosteroids effective in treating phimosis in boys?

EVIDENCE-BASED ANSWER

Compared with placebo or no treatment, topical corticosteroids may increase the frequency of complete resolution (number needed to treat [NNT] = 5) and partial resolution (NNT = 11) of phimosis in boys after 4 to 8 weeks of treatment.¹ Compared with placebo, topical corticosteroids also may increase the probability of long-term complete resolution of phimosis in boys 6 months or more after treatment (NNT = 3). There is likely little to no difference in adverse effects compared with placebo.¹ (Strength of Recommendation: B, based on inconsistent or limited-quality patient-oriented evidence.)

PRACTICE POINTERS

Phimosis is a condition characterized by the inability to fully retract the penile foreskin past the glans. Physiologic phimosis is present at birth, includes normal preputial skin, and often resolves spontaneously during the first 3 to 4 years of life. Pathologic phimosis, defined by the presence of phimosis associated with an inability to retract the foreskin due to distal scarring of the prepuce, can occur because of infection or inflammation, among other causes. It can be difficult to clinically distinguish between physiologic and pathologic phimosis. Approximately 10% of 3-year-old boys and 1% of 16-year-old boys have phimosis.¹ Persistent phimosis may lead to complications such as penile inflammation, pain, sexual dysfunction, and, in rare cases, penile cancer.² Retraction of the foreskin in children with phimosis could lead to paraphimosis, in which foreskin is entrapped behind the coronal sulcus. Although uncommon, this is a medical emergency with an incidence of 0.2% in children.³