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Lichen Sclerosus/BXO Advice Needed

LSpatient profile image
33 Replies

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It's just over 2 weeks now after my circumcision due to Lichen sclerosus/BXO and I wanted to ask for any advice... How does this look to any professionals out there or people who have the same condition? Initially after my circ, a few large blisters formed which were extremely painful. I sterilised a sewing needle and popped the blisters and drained them for around 2 days before they closed properly. I've now been monitoring them closely and using the steroid cream Dovate. The blisters now just look like white cell-like patches on my glans. The cream is helping to stop the pain which is a win, but the redness is still there and it doesn't look great... I've been walking around with a bandage over my penis out of fear if blisters forming again. However, I need to let my glans get used to the friction at the same time. Any advice?

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LSpatient
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S2BC profile image
S2BC

" Steroid creams have been shown to limit the progression of the disease but do not offer a cure in the majority of cases.[1] The progression of the BXO disease gets arrested following circumcision by removing the urine-rich environment and patients with meatal or urethral disease are most likely to require excision and/or reconstruction for a long-lasting cure."

ncbi.nlm.nih.gov/pmc/articl...

S2BC profile image
S2BC

I may try to cover the blisters area with a piece of thin hydrocolloid dressing and stop using steroid cream, cause the environment without prepuce is different now.

LSpatient profile image
LSpatient in reply toS2BC

Why hydrocolloid specifically? And why do you suggest the stoppage of the steroid cream? Wont the situation just continue to get aggravated if I dont continue using it?

S2BC profile image
S2BC in reply toLSpatient

How long time you have used steroid cream, now? Or just started after cut?

I may try myself , I don't ask you to do that. ;) You know your skin better than me.

Why hydrocolloid? It is half-permeable and stop the pain on that particular area. A piece of it can be cut with a scissors like 2x3 cm, just covering the blisters area and stick it with skin tape. There are still al lot of penis to get used to the friction. Steroid cream or Elida can be apply under the hydrocolloid.

I cover and protect my wound line with an 3 cm wide strip of 'Duoderm extra thin' dressing and apply honey ointment to keep the wound moist.

LSpatient profile image
LSpatient in reply toS2BC

I only started after my circumcision (around 9 days after the op)

The are isn't in pain at all - my worry is that the friction will cause it to become painful and blister again. I might try the hydrocolloid dressing and see how that goes though! I obviously dont want to have to walk around with the dressing forever though, so I'll still need the area to get used to the friction.

S2BC profile image
S2BC in reply toLSpatient

I'll hope the blisters are gone on time of your two weeks celibacy. ;)

LSpatient profile image
LSpatient in reply toS2BC

I don't have the blisters anymore, I popped and drained them! I'm just worrying that they come again due to friction!

And haha thank you

LSpatient profile image
LSpatient in reply toS2BC

And also - I need the penis to get used to the friction of my pants

LSpatient profile image
LSpatient in reply toS2BC

Also - what would you say to using a 1% non-steroid cream such as Elidel?

At1012 profile image
At1012

Wow, the whiteness of your glans definitely looks deeper than just the skin. That looks so painful. Did you try putting extra virgin unrefined organic coconut oil on your penis particularly in the frenulum area? Another suggestion to try is getting a prescription for valtrex. This medication is used for genital herpes, but remember a common cold sore that the majority of the population has, can spread to the genitals. Do you have a burning sensation in the frenulum area? If you do, I would ask doctor to prescribe valtrex for you. I honestly believe that a lot of these foreskin conditions are really just undiagnosed herpes.

LSpatient profile image
LSpatient in reply toAt1012

Yeah, the whiteness has gradually increased. It actually isn't painful, mainly thanks to the steroid cream I think. I have been putting on extra virgin coconut oil! My frenulum area isn't affected at all fortunately! It's just the red area at the tip that's the problem, along with the area that blistered

MrMac99 profile image
MrMac99

Hi Man, that definitely looks like LS. I am surprised your doctor's we're not able to diagnose this sooner. You should continue with the steroid cream and hopefully now that your glans are exposed the condition with improve. it is important that your glans dry out now that is what will help to stop the LS, this may involve the skin to peel, after that happens the sensitivity will decrease. there's no easy way to desensitized the glans only to persevere. continue with the dry dressing to make it more comfortable. You should have a follow-up appointment to monitor the condition and to discuss the length of time you need to be using the steroid cream. Do you have any trouble peeing?

LSpatient profile image
LSpatient in reply toMrMac99

Thank you so much for this advice! It will help! I am surprised too that they took that long, it's a bit frustrating! I will allow it to dry out now then! I have been moisturizing the glans thinking that that will help the disease! I've clearly been doing the wrong thing haha! I'll use a dry dressing then! I'm booking an appointment with a very good dermatologist in my area soon! I have no trouble peeing at all fortunately! So I'm glad it hadn't affected the urethra!

in reply toLSpatient

I am pleased you have got yourself a dermatology appointment. LS is a serious condition and needs to be properly dealt with. Let us know how your consultation goes. Take care.

LSpatient profile image
LSpatient in reply to

Thank you! I will let you know how it goes and all!

MrMac99 profile image
MrMac99 in reply toLSpatient

That's good news you have no trouble peeing and definitely see your dermatologist. and do let us know how you get on.

if it's very uncomfortable you could use a little moisturiser but try and let it dry out as much as you can.

LSpatient profile image
LSpatient in reply toMrMac99

Yes, definitely! I'll fill you all in on how it goes and what he says!

I think apart from the steroid cream, I'm not going to put anything on

MrMac99 profile image
MrMac99 in reply toLSpatient

Yes I think that you are right it would be best to only use the steroid cream for now.

LSpatient profile image
LSpatient in reply toMrMac99

Great, it's comforting that you agree! When wearing pants do you reccomend that I let it rub against the underwear or that I put a bandage over?

MrMac99 profile image
MrMac99 in reply toLSpatient

That depends if it is comfortable for you to not wear a bandage I did use a dressing for the first two to three weeks when I was working during day but in the evening time I tried without eventually the glans will desensitise.

LSpatient profile image
LSpatient in reply toMrMac99

Ah alright, I see! I think I'll do a mixture until its desensitized! Thank you!

Galen70 profile image
Galen70

I a m slightly confused by your post as it mentions the circ was done for LS , but then there seems to be a discussion about seeing a doc to manage the condition subsequently. If you have glans changes also, then its appropriate to treat this with topical steroids for a period of time. Dermovate ( clobetasol propionate ) is however a very potent steroid and should be used for the minimum amount of time to control symptoms. In the UK, this condition would be followed up by either dermatologists or sexual health doctors. The pics you have posted show a good result from circumcision , no evidence of active infection from what I can see , and the paleness ( pallor ) is relatively mild. I am not sure if you have used steroid there extensively or not previous to the circ. The skin also needs to adapt to the circumcision. I know some people pop a condom over the penis when out and about in the early days to reduce sensitivity until the skin adjusts. Remember circumcision is not always 100% curative for LS and you should monitor your penis for any new skin changes and see a Dr if it does.

LSpatient profile image
LSpatient in reply toGalen70

The circ was done as the LS had caused phimosis- that was the primary reason. It was also done out of hope that the surgery would help to cure the LS on the glans as it had been researched to do. After it was done, my glans blistered and was extremely painful. I managed to drain them, however, and am now going to see another dermatologist about how to handle it fully. The glans has become less sensitive in the infected area but still looks bad and I'm very worried about it blistering again. I am currently using Dovate. I don't intend on using it for extended periods of time. I have been advised by a previous doc to then switch to Elidel, a 1% non-steroid cream. Do you think this would be a good idea? It's comforting to know that you think that there has been a good result from the circ and see no active infection, etc.! I have only started using the steroid cream post-op as prior, it had annoyed my foreskin and made it itch. I've been bandaging it up to cope with the sensitivity so far! I'm definitely going to monitor it and book an appointment if anything changes!

Also - what are your views on Emuaid ointment?

Thanks for the reply!

LSpatient profile image
LSpatient in reply toLSpatient

Has* been

Lichoman88 profile image
Lichoman88

Hi How are the glands looking now since your circumcision. My glands look very similar yours, I am currently uncircumcised and Would really like to know if your glands has improved. Is the skin returning back to normal colour again?

BXOpatient27 profile image
BXOpatient27

I had the circum circumcision around 6 years ago and then follow up with a bucal mucosa skin graft for reconstruction of the urethra around 18 months later.. The circumcision didn't work for me, nor the steroid creams, antibiotics and pain relief was unpredictable due to when and how the pain would occur and trying too time my pain killers. I was told that a bucal mucosa skin graft is 80% successful and that it usually gives patients around 5 years before BXO returns. In which it was 3.5 years before it came back and I'm now catheterised again due to the progression... Whilst the condition is prominent and present Ive started noticing glass like shards of what seems too be stone or crystalized urine coming out. Drinking water and keeping the bladder active will help with the over active bladder symtomes, howeather I have too drink enough that I need the toilet every ten minutes which isnt great for general health as I started getting migraines from over hydration. But keeping a balance will smooth out the pain. There seems too be a sweet spot between in the water intake which the bladder stays busy and eases the spasms speaking in past terms until last few weeks. Ive began too slip out of my routines due to the depression and pain lately. My bladder has only been holding approximately 100ml maximum and after suprapubic emptying I feel like I still need to urinate and my bladder stays under pressure until it fills a little. But overall a bucal mucosa skin graft difinitely was a worrying surgical procedure for me at 22 years old but it gave me 3.5 years of my life back to me which too this day my specialist is well respected for considering I live since 10 years old with noticeable problems.

Terrylacker14 profile image
Terrylacker14 in reply toBXOpatient27

Hi mate, sorry to hear about your horrific issues. Just from your experience, did the circumcision sort out your lichen Sclerosus on the glans penis? I guess it had already travelled too far down the urethra to actually cure the condition. I hope you find some relief down the line my friend. What are your next steps?

MrMac99 profile image
MrMac99 in reply toBXOpatient27

Hey Man, sorry to hear about your struggle with LS it can be a very destructive condition to have. It's very important you keep going with the treatment it sounds like you need to have a urethral reconstruction again hopefully it will improve the condition for you and you get longer this time. my heart goes out to you it must be a really worrying for you you're very unfortunate the circumcision did not stop the condition from spreading. All the best Man keep us posted on how you get on.

BXOpatient27 profile image
BXOpatient27

Circumcision and the white patches on the glands helped I didn't find hydrocortisone or steroid creams helped tbh... Just now I strictly drink water approximately 6 x 500ml a day too keep my urine less concentrated and that seems too help and arguably a lot more than antispasm tablets or painkillers or anything tbh.. After I got my circumcision the white patches dissapated but if i get for example common infections or so on the white patches become more noticeable. My specialist is currently doing extensive tests and hopefully I can get another urethral reconstruction more meatus at the tip done... But I honestly swear by plenty of water and reconstructive surgery aspecially if patients are catheterised.

MrMac99 profile image
MrMac99 in reply toBXOpatient27

That's great man you are getting the proper treatment I would definitely agree with you about the water diluting the urine that would be very helpful in not aggravating the condition and avoiding any UTI you could get

Terrylacker14 profile image
Terrylacker14

Good to hear from you mate. So did the circumcision help the symptoms you had on your glans? Is your glans actually okay now? The way I understand it your main problem is the LS obviously spread up your urethra. Really sorry to hear it went like for you. Keep the positive thoughts though buddy. Hopefully another Urethrel reconstruction will be enough to keep the LS at bay this time. It will all work in out in the end my friend.

BXOpatient27 profile image
BXOpatient27 in reply toTerrylacker14

I used too get white large patched blisters on the glands and drain them also.... after the circumcision the white scarring is still present but it no where near as prominent. Changes in urine acidity and so kind of changes how the scar tissue looks on the glands I don't know if it's nerves or what.... But after circumcision I didn't get blisters at all just the urethral problems with LS.

The things I noticed before the circumcision was

Tight foreskin and couldn't retract it back, the tip of foreskin having a white ring around it, red blotchy meatus and 1 white large blister on each gland almost simetrical.

After circumcision precedure,

Sensitivity was a bit irritable but went away quite fast, the white blisters turned to scarring, the redness calmed down and the only bad thing I actually noticed with the circumcision was the fine line scar of where the incision was made, but even so after a while even that stretched out too a red kind of more natural appearance. I had uriting problem since I was around 10 years old and I honestly wish I got circumsized back then because its made half of the problems a complete distant memory.

Terrylacker14 profile image
Terrylacker14 in reply toBXOpatient27

Ah okay I get you. So your symptoms on your glans have now virtually cleared up, your just left with the residual BXO scarring? Sounds like you’ve been through quite a time of it. Crazy that you’ve essentially had LS since you were 10 years old. I’m currently monitoring my symptoms.. I have glans redness and was initially diagnosed with LS. They’ve backtracked slightly now and have said that if it is LS, it’s a mild and inactive case. But it may very well not be, so I’m just waiting to see how it pans out and if it gets any worse I’ll get circumcised in attempt to cure it.

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