clobetasol and Phimosis

Until recently, phimosis has been treated surgically by circumcision or prepuceplasty; however, recent reports of non-invasive treatment using topical corticosteroids applied for four to eight weeks have been favourable. The efficacy and safety of topical corticosteroids for treating phimosis in boys has not been previously systematically reviewed.. We aimed to 1) compare the effectiveness of the use of topical corticosteroid ointment applied to the distal stenotic portion of the prepuce in the resolution of phimosis in boys compared with the use of placebo or no treatment, and 2) determine the rate of partial resolution (improvement) of phimosis, rate of re-stenosis after initial resolution or improvement of phimosis, and the rate of adverse events of topical corticosteroid treatment in boys with phimosis.. We searched the Cochrane Renal Group's Specialised Register through contact with the Trials' Search Co-ordinator using search terms relevant to this review. Date of last search: 16 June 2014.. We included all randomised controlled trials (RCTs) that compared use of any topical corticosteroid ointment with placebo ointment or no treatment for boys with phimosis.. Two authors independently assessed titles, abstracts and the full-text of eligible studies, extracted data relating to the review's primary and secondary outcomes, and assessed studies' risk of bias. Statistical analyses were performed using the random-effects model and results were expressed as risk ratios (RR) for dichotomous outcomes with 95% confidence intervals (CI). We contacted authors of primary articles asking for details of study design and specific outcome data.. We included 12 studies that enrolled 1395 boys in this review. We found that both types of corticosteroids investigated and treatment duration varied among studies.Compared with placebo, corticosteroids significantly increased complete or partial clinical resolution of phimosis (12 studies, 1395 participants: RR 2.45, 95% CI 1.84 to 3.26). Our analysis of studies that compared different types of corticosteroids found that these therapies also significantly increased complete clinical resolution of phimosis (8 studies, 858 participants: RR 3.42, 95% CI 2.08 to 5.62). Although nine studies (978 participants) reported that assessment of adverse effects were planned in the study design, these outcomes were not reported.Overall, we found that inadequate reporting made assessing risk of bias challenging in many of the included studies.Selection bias, performance and detection bias was unclear in the majority of the included studies: two studies had adequate sequence generation, none reported allocation concealment; two studies had adequate blinding of participants and personnel and one had high risk of bias; one study blinded outcome assessors. Attrition bias was low in 8/12 studies and reporting bias was unclear in 11 studies and high in one study.. Topical corticosteroids offer an effective alternative for treating phimosis in boys. Although sub optimal reporting among the included studies meant that the size of the effect remains uncertain, corticosteroids appear to be a safe, less invasive first-line treatment option before undertaking surgery to correct phimosis in boys.

Topics: Administration, Topical; Adrenal Cortex Hormones; Beclomethasone; Betamethasone; Clobetasol; Glucocorticoids; Humans; Hydrocortisone; Male; Mometasone Furoate; Ointments; Phimosis; Pregnadienediols; Randomized Controlled Trials as Topic; Triamcinolone

We report a prospective randomized study comparing the effects of highly potent and moderately potent topical steroids in treating pediatric phimosis.. A total of 70 boys 1 to 12 years old with phimosis were randomly assigned to receive topical application of either betamethasone valerate 0.06% (a highly potent steroid) or clobetasone butyrate 0.05% (a moderately potent steroid). Parents of the boys were instructed to retract the foreskin gently without causing pain, and to apply the topical steroids over the stenotic opening of the prepuce twice daily for 4 weeks, then for another 4 weeks if no improvement was achieved. Retractibility of the prepuce was graded from 0 to 5. Response to treatment was arbitrarily defined as improvement in the retractibility score of more than 2 points.. Mean treatment and followup periods were 4.3 and 19.1 weeks, respectively. The response rates in boys treated with betamethasone valerate and clobetasone butyrate were 81.3% and 77.4%, respectively (p = 0.63). Mean retractibility score decreased from 3.9 +/- 1.0 to 1.7 +/- 1.1, and 4.2 +/- 1.0 to 1.9 +/- 1.0 in the betamethasone and clobetasone groups, respectively. Both steroids were effective in all age groups. Pretreatment retractibility score did not affect treatment outcomes. No adverse effect was encountered.. Highly potent and moderately potent topical steroids are of comparable effectiveness in treating phimosis. A less potent steroid may be considered first to decrease the risk of the potential adverse effects.

Topics: Administration, Cutaneous; Betamethasone Valerate; Child; Child, Preschool; Clobetasol; Follow-Up Studies; Glucocorticoids; Humans; Infant; Male; Phimosis; Prospective Studies; Single-Blind Method; Treatment Outcome

To assess whether it is the steroid alone or the gentle physical retraction combined with ointment that is responsible for the excellent results observed with topical steroid treatment of unretractable foreskin.. Prospective, randomised, double-blind study.. University hospital, Sweden.. 30 Boys randomised to be treated with clobetasol propionate (n = 15) or placebo (n = 15).. The boys were examined 1, 2 and 6 months, respectively, after treatment.. Comparison between the effects of clobetasol propionate and placebo.. Two patients in the steroid group and one in the placebo group withdrew from the study. 10 Boys in the steroid group showed an improvement within 2 months. The remaining 3 boys had no effect and were circumcised. Histopathological examination showed lichen sclerosus et atrophicus. Seven boys in the placebo group improved. The 7 non-responders were prescribed clobetasol propionate ointment, and all 7 improved.. 17 of 27 boys referred with "phimosis" were successfully treated with an ointment and gentle traction. When clobetasol propionate was given the non-responders success rate was increased to 24/27 (89%).

Topics: Administration, Topical; Anti-Inflammatory Agents; Child; Child, Preschool; Circumcision, Male; Clobetasol; Diagnosis, Differential; Double-Blind Method; Glucocorticoids; Humans; Lichen Sclerosus et Atrophicus; Male; Penile Diseases; Phimosis; Prospective Studies; Treatment Outcome

In an open trial, including 54 boys with phimosis, treatment with clobetasol propionate cream (Dermovate, Glaxo, UK) was shown to be effective, without side effects. Surgery, the treatment of choice in many centres, was avoided in 70% of the patients.

Topics: Administration, Topical; Adolescent; Child; Child, Preschool; Clobetasol; Humans; Male; Ointments; Phimosis

One of the most frequent complications after circumcision by thermocautery is phimosis. In this study, we aimed to present the functional and cosmetic results of the modified sleeve technique for the correction of this iatrogenic phimosis.. The study group included iatrogenic phimosis cases who underwent circumcision using thermocautery during the last eight years. Initially, steroid creams were applied on these patients for six weeks. Patients who did not respond to this treatment underwent surgery using the modified sleeve technique. Control visits were performed at the first and fourth postoperative weeks.. A total of 32 patients with a median age of 5.1±1.1 years were included in the study out of 13285 circumcisions by thermocautery. No positive treatment outcomes were obtained by topical steroids, and all patients proceeded to surgery by modified sleeve technique. Median operative time was 25±2.3 minutes. Cosmetic and functional outcomes were satisfactory in all cases.. There is no place for topical steroids in management of iatrogenic phimosis after thermocautery is observed, thus, early surgery is advised to avoid emotional stress. Our modified sleeve technique can achieve maximum cosmetic and functional outcomes without leading to extreme shortening of the penile skin and mucosa.

Topics: Administration, Cutaneous; Anti-Inflammatory Agents; Child; Child, Preschool; Circumcision, Male; Clobetasol; Electrocoagulation; Humans; Infant; Male; Phimosis

To investigate the clinical effect of 0.02% clobetasol propionate cream (CPC) on phimosis in prepubertal children.. We retrospectively analyzed the clinical data about 237 prepubertal children with phimosis present at the Outpatient Department from June 2012 to December 2015. The patients were aged 2－14 (mean 8.6) years, all treated by topical application of 0.02% CPC to the narrowed opening and adhered part of the foreskin twice a day, in the morning and evening respectively. At the time of CPC application, the foreskin was slightly retracted. We evaluated the therapeutic effect every week from the end of the first week of treatment.. Totally, 233 of the patients completed the 8-week treatment, of whom 181 (77.68%) showed full retraction of the foreskin, 28 (12.01%) experienced improvement (disappearance of the phimotic ring), and 24 (10.30%) failed to respond, with a total effectiveness rate of 89.70%. No significant local or systemic adverse reactions were observed during the treatment.. Topical application of 0.02% Clobetasol Propionate Cream is a safe, effective, painless, and inexpensive option for the treatment of phimosis in prepubertal chilodren.. 目的: 探讨0.02%丙酸氯倍他索乳膏治疗小儿包茎的临床疗效。方法: 选取 2012年6月至2015年12月门诊包茎患儿237例，年龄2～14岁，平均8.6岁。按照包茎程度分为5组，分别给予0.02%丙酸氯倍他索乳膏，早晚各1次涂抹于包皮狭窄开口及粘连处，每次用药时轻微用力上翻包皮，每周门诊随访评价疗效，疗程最长8周。结果: 失访4例，共有233例患儿获得随访。181例患儿完全治愈，包皮外口狭窄环消失，包皮粘连处松解，可自由翻转以显露阴茎头，治愈率为77.68%；28例(12.01%)患儿有效，狭窄环部分松解可显露部分阴茎头，尚不足自由翻转显露阴茎头；无效患儿24例(10.30%)，包皮外口狭窄仍不能上翻显露阴茎头。总有效率为89.70%，治疗过程中无明显不良反应发生。结论： 0.02%丙酸氯倍他索乳膏治疗小儿包茎是一种安全、有效、无痛、经济的方法。.

Topics: Administration, Topical; Adolescent; Anti-Inflammatory Agents; Child; Child, Preschool; Clobetasol; Foreskin; Gels; Humans; Male; Outpatients; Phimosis; Retrospective Studies; Treatment Outcome

Topics: Balanitis; Child; Clobetasol; Glucocorticoids; Humans; Male; Phimosis

Topics: Child; Clobetasol; Glucocorticoids; Humans; Male; Phimosis

Topics: Adolescent; Child; Child, Preschool; Clobetasol; Glucocorticoids; Humans; Hypothalamo-Hypophyseal System; Male; Phimosis; Pituitary-Adrenal System

Corticoids have been an option for phimosis treatment since 1993. However, long-term use or repeated cycles pose a concern regarding drug absorption and consequent systemic effects. The aim of this study was to investigate the effect of topical corticoids used in treating phimosis on the hypothalamus-pituitary-adrenal axis in children.. A total of 31 children were included in the study. Cortisol secretion was evaluated by the measurement of salivary cortisol in saliva samples collected at 9:00 a.m. before starting treatment and after 8 weeks of topical treatment with 0.05% clobetasol propionate. Salivary cortisol was determined by radioimmunoassay. To confirm that use of clobetasol propionate was not detected by the assay, the presence of cortisol circadian rhythm was checked by an extra saliva sample obtained at 11:00 p.m. from 10 children, and was observed to be maintained in all of them.. No significant difference in salivary cortisol levels was observed between samples obtained at 9:00 a.m. before starting treatment and after completing treatment when the entire group was analyzed. However, in 2 children the salivary cortisol levels after treatment were lower than the cutoff value (358 ng/dl) assumed to be suggestive of hypothalamus-pituitary-adrenal axis suppression.. Topical clobetasol propionate used twice daily for clinical treatment of phimosis does not affect the hypothalamus-pituitary-adrenal axis in most patients. However, salivary cortisol level should be considered as a laboratory marker in long-term treatment or during repeated cycles to detect possible hypothalamus-pituitary-adrenal axis suppression.

Topics: Adolescent; Child; Child, Preschool; Clobetasol; Glucocorticoids; Humans; Hydrocortisone; Hypothalamo-Hypophyseal System; Male; Phimosis; Pituitary-Adrenal System; Saliva

This study was designed to evaluate the efficacy of topical application of corticosteroid cream in the treatment of phimosis in children and to compare the results obtained with those reported in the literature.. In the context of a prospective study conducted between January 1997 and November 2001, 108 children with a mean age of 5.9 years, presenting with true phimosis preventing retraction of the foreskin, were treated by twice-daily application of 0.05% clobetasol propionate cream for 10 days. The results were evaluated at one month and then every six months by a urologist in the outpatients department. A second course of treatment identical to the first was proposed in the case of failure or partial efficacy.. 96 children were evaluated with a mean follow-up of 14 months (range: 6 to 24 months). Seventy nine children (82%) are cured after a first course of treatment. In the remaining 17 children, 2 were treated by circumcision and 15 received a second course of treatment resulting in cure in another 9 cases. The final cure rate was therefore 92%. Among the six failures, 4 children were circumcised, corresponding to a total of 6 circumcisions out of this series of 96 cases of phimosis (6%). No local or systemic adverse effects related to steroid therapy were observed and no recurrence of phimosis was observed during the study.. This study confirms the efficacy and safety of local steroid therapy in the treatment of phimosis in children. Surgical treatment of phimosis should therefore be reserved for failures of medical treatment and has now become much less frequent.

Topics: Administration, Topical; Adolescent; Anti-Inflammatory Agents; Child; Child, Preschool; Clobetasol; Follow-Up Studies; Glucocorticoids; Humans; Male; Phimosis; Prospective Studies

The current treatment of phimosis in Denmark is surgical. Reports of success rates of 70-80% with topical steroids have prompted us to carry out the present study.. Parents of boys, who were referred because of phimosis, volunteered to participate in an open trial of topical clobetasol 0.05%, along with gentle mobilisation of the foreskin once daily for 4-6 weeks. Fifty-five boys completed the treatment. The results were recorded at clinical follow-up four and six weeks later, and a long-term follow-up was done by questionnaire sent after 9-11 months.. At six weeks of treatment, 42 had a fully retractable foreskin, 11 a partially retractable foreskin, and two had unchanged phimosis. Ten patients had a circumcision or plasty. At long-term follow-up, 12 had a symptomatic recurrence. Four of these were given surgical treatment and eight had a repeat topical treatment, which was effective in six. The overall effect was independent of the degree of phimosis. Four patients with obvious sacrified foreskin failed. Twelve patients had agglutinations, which became apparent after the treatment for phimosis. We recorded no systemic and very few local side effects. The patients and parents found the treatment convenient and satisfactory.. Topical clobetasol 0.05% once a day for 4-6 weeks can be recommended as primary treatment in phimosis in boys without scarification of the foreskin. The treatment may be repeated as necessary.

Topics: Administration, Topical; Adolescent; Anti-Inflammatory Agents; Child; Child, Preschool; Clobetasol; Follow-Up Studies; Glucocorticoids; Humans; Male; Ointments; Patient Satisfaction; Phimosis; Prognosis; Surveys and Questionnaires

The aim of this study was to evaluate the efficacy of topical applications of clobetasol propionate cream in the treatment of phimosis in boys and a comparison of the results presented with an overview of the current studies.. In a prospective study, 94 boys (mean age 5.5 years) were treated with topical applications of 0.05% clobetasol propionate cream twice daily. The prepuce was treated for 1 month, with an attempt at prepuce retraction after 14 days. The boys were evaluated after 1 month of treatment and every 3 months during follow-up.. Of the 94 boys, 91 were available for follow-up, of whom 42 boys (46.1%) achieved complete retraction of the prepuce, 24 (26.4%) had only preputial adhesions and 4 (4.4%) had partial retraction. Twenty-one boys (23.1%) had no response. The treatment was continued in 13 boys with good results eventually. Seven boys (7.7%) had recurrence after a mean follow-up of 4.3 months (range 2-7). No side effects were noted. Circumcision was necessary in 24 of the 91 boys (26.4%). The mean follow-up was 11.0 months (range 3-18).. Local application of clobetasol propionate cream is a simple, safe and effective treatment for phimosis in boys and avoids circumcision and its associated risks. It should be offered first instead of circumcision.

Topics: Administration, Topical; Anti-Inflammatory Agents; Child; Child, Preschool; Clobetasol; Glucocorticoids; Humans; Male; Phimosis; Prospective Studies

The effectiveness of topical steroid application in relieving phimosis was studied in 41 boys treated with a potent steroid ointment. 35 patients showed improvement initially but in 12 of them the phimosis recurred completely and in seven of them partly. There was significantly less recurrence in the patients who improved within one month. Most of the families were satisfied with the treatment. We recommend topical steroids as first treatment of choice for phimosis, when treatment is necessary.

Topics: Administration, Topical; Anti-Inflammatory Agents; Child; Child, Preschool; Clobetasol; Glucocorticoids; Humans; Male; Phimosis

Topics: Child; Clobetasol; Humans; Male; Ointments; Phimosis