Balanitis Xerotica Obliterans Medication

Updated: Nov 11, 2019
  • Author: Amira M Elbendary, MBBCh, MSc; Chief Editor: William D James, MD  more...
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Medication Summary

Topical steroids, especially superpotent topical steroids, are the mainstay of medical therapy. Zavras et al reported successful treatment of 1079 (91.1%) of 1185 boys with a diagnosis of phimosis using fluticasone propionate 0.05%, including boys with mild balanitis xerotica obliterans (BXO). [48]  Ultrapotent steroids are typically applied daily for the first 3-4 weeks, then on weekends.

Topical testosterone is mostly ineffective and is not discussed further. Etretinate has been used with limited success but is no longer available for prescription in the United States.


Topical corticosteroids

Class Summary

Topical corticosteroids help reduce inflammatory lesions and may reduce or resolve lesions.

Clobetasol (Temovate)

Clobetasol is a class I superpotent topical steroid; it suppresses mitosis and increases synthesis of proteins that decrease inflammation and cause vasoconstriction. Clobetasol is used in most studies dealing with treatment of lichen sclerosus.


Topical immunomodulators

Class Summary

Topical calcineurin inhibitors are immune suppressants that block early T-cell activation, degranulation of mast cells, and multiple cytokines.

Tacrolimus ointment 0.1% or 0.03% (Protopic)

The mechanism of action for tacrolimus ointment in atopic dermatitis is not known. It reduces itching and inflammation by suppressing the release of cytokines from T cells. It also inhibits transcription for genes that encode IL-3, IL-4, IL-5, GM-CSF, and TNF-alpha, all of which are involved in early stages of T-cell activation. Additionally, tacrolimus ointment may inhibit the release of preformed mediators from skin mast cells and basophils and may down-regulate expression of FCeRI on Langerhans cells. It can be used in patients aged 2 years or older. It is more expensive than topical corticosteroids. It is available as ointment in concentrations of 0.03 and 0.1%. Tacrolimus ointment is indicated only after other treatment options have failed.