BXO is a condition that affects the end of the penis, or glans. A hard white lump develops in delicate skin or mucosa, usually around the urethra or opening. Around the lump there may be a reddened area or halo.
BXO is an overall description of a collection of problems found in a group of different conditions, the most common of which is called lichen sclerosis et atrophicus (also known as Csillag's disease or white spot disease).
Women may also develop this condition, where it affects the skin and mucosa of the vulva or genital area.
In most cases, the scarring and thinning of the mucosa begins in young adulthood and can progress, leading to a narrowing of the urethra and difficulty passing urine.
Other symptoms include soreness and itching in the area and sometimes ulceration. Occasionally cancerous changes develop.
The cause of BXO is unknown, so it's difficult to target treatment at any specific process.
Abnormalities have been detected in the collagen in the skin layers but the significance of this isn't clear. Some experts think it may be an inflammatory disease but no cause or infectious organism has been found to account for the inflammation.
It has been suggested that BXO may be an autoimmune disorder, where the body's immune system attacks the tissues. Other experts have linked it to certain bacterial infections. However, there's no strong evidence of either.
Others draw links to previous trauma or surgery, which may play a part but don't explain why the condition progresses.
Steroid creams and ointments may lead to some improvement and help to reverse the changes of BXO. Some people have used testosterone cream with some success.
There are also some experimental and unproven treatments, such as immunosupressant drugs, and retinoids (Vitamin A derivatives). Your urologist is the best person to tell you more about these.
Lichen sclerosis et atrophicus is also treated by dermatologists, who may have more specialist knowledge. Ask your urologist whether it's worth getting an opinion from a dermatologist.
BXO tends to develop in the warm, moist, urine-exposed environment that exists under the foreskin, which explains why BXO is rare among men circumcised in childhood. In removing the moist skin folds and allowing the surface of the glans to dry out, circumcision usually stops symptoms and often cures the disease totally.
Recent research has shown that circumcision can be very effective in halting the disease, especially if BXO is limited to the foreskin or glans only, and the urethra isn't affected.
In some cases BXO reoccurs, particularly when some foreskin is left intact or when there are still moist skin folds because of obesity.
(In the past, there was some concern that circumcision might increase the risk of progression of BXO. As more research has been carried out, it has become clear that while circumcision in childhood protects against BXO, circumcision in adult life may be followed by complications caused by BXO which had not been diagnosed beforehand.)
