Composition of the Inflammatory Infiltrate in Pediatric Penile Lichen Sclerosus Et Atrophicus (Balanitis Xerotica Obliterans): A Prospective, Comparative Immunophenotyping Study

Abstract

Dermatopathological evaluation of pediatric preputial inflammatory disease rarely allows for specific diagnosis other than pediatric penile lichen sclerosus et atrophicus (balanitis xerotica obliterans, LSA/BXO). A prospective immunopathological study was performed on 20 consecutive, unselected, clinically and histopathologically confirmed LSA/BXO cases to determine the relative presence of T and B lymphocytes. There were seven cases with early stages of disease, eight with florid disease, and five with later stages of disease. Two ritual circumcision specimens and 12 specimens with non-LSA/BXO balanitis, collected during the same period, were used as controls. The infiltrate in LSA/BXO patients was wholly composed of T cells (positive with UCLH-1 antibody) in all cases. B cells (positive with L-26 antibody) were found only focally in small, discreet, easily recognizable (follicular or early follicle-like) aggregates, positioned slightly deeper than the band-like infiltrate of T cells. T cells were inconspicuous in 9 of the 12 control specimens. In the three other controls, T cells were much more obvious and these patients showed clinical features possibly suggestive of LSA/BXO in early, prediagnosable phases of development. We conclude that limited immunophenotyping may be a useful adjunct to diagnosis in pediatric cases in which only limited tissue is available or the disease may be more difficult to classify with confidence.

Balanitis xerotica obliterans in children and its incidence under the age of 5 years

“…In the advanced stages, dermal collagen forms a homogenous band at the dermal-epithelial junction in conjunction with elastin fibres, to produce an amorphous hybrid substance [15]. Deep to this amorphous band, a chronic inflammatory cell infiltration, mainly from T cells, is present [16]. The differential diagnosis of BXO might include non-specific inflammation, lichen planus, localized scleroderma, leukoplakia, vitiligo and the cutaneous rash of Lyme disease [3].…”

High Incidence of Balanitis Xerotica Obliterans in Boys with Phimosis: Prospective 10‐Year Study

“…Suspected pathogenic mechanisms include hereditary factors, hormonal imbalance, borreliosis, herpesvirus (HPV) infection, and dysregulation of the immune system (1–4). Balanitis xerotica obliterans is characterized by pathologic changes in the epidermal basement zone with features suggesting a continuous cascade process of collagen degeneration and regeneration (5,6).…”

Male circumcision – see the harm to get a balanced picture

“…e. Length of the foreskin is not diagnostic of disease. f. Balanitis xerotica obliterans (BXO) is more properly referred to as lichen sclerosus [50][51][52][53][54][55]. 2.…”