Changes

Freeman and Laymon (1941) provide a detailed classic description of the disease:<ref>Freeman C, Laymon CW. [http://www.cirp.org/library/treatment/BXOname="freeman" /freeman1/ Balanitis xerotica obliterans]. ''Arch Dermat Syph'' (Chicago) 1941;44;(4):547-559.</ref> BXO is usually distinguished by a ring of hardened tissue with a whitish color at the tip of the [[foreskin]]. The hardening of the tissue prevents [[retraction of the foreskin]].<refname="shankar">Shankar KR, Rickwood AM. [http://www.cirp.org/library/treatment/phimosis/shankar1/ The incidence of phimosis in boys]. ''BJU Int'' 1999;84(1):101-2.</ref> Immunophenotyping may be useful in differential diagnosis.<ref>Hinchliffe SA, Ciftci AO, Khine MM, ''et al.'' [http://www.cirp.org/library/treatment/BXO/hinchliffe1/ Composition of the inflammatory infiltrate in pediatric penile lichen sclerosus et atrophicus (balanitis xerotica obliterans): a prospective, comparative immunophenotyping study]. ''Pediatr Pathol'' 1994;14(2):223-33.</ref> Histologic examination of cutaneous biopsy gives a definite diagnosis.<ref>Pasieczny TAH. [http://www.cirp.org/library/treatment/BXO/pasieczny1/ The treatment of balanitis xerotica obliterans with testosterone propionate ointment]. ''Acta Derm Venerol'' (Stockholm) 1977;57:275-277.</ref><ref>Rickwood AMK, Hemalatha V, Batcup G, Spitz L. [http://www.cirp.org/library/treatment/phimosis/rickwood/ Phimosis in Boys]. ''Brit J Urol'' 1980; 52:147-150.</ref><ref>Shankar KR, Rickwood AM. [http://www.cirp.org/library/treatment/phimosis/shankar1/ The incidence of phimosis in boys]. ''BJU Int'' 1999;84(1):101-2.</ref><ref>Depasquale I, Park AJ, Bracka A. [http://www.cirp.org/library/treatment/BXO/depasquale1/ The treatment of balanitis xerotica obliterans]. ''BJU Int'' 2000;86(4):459-465.</ref> The presence of BXO must be confirmed in order to consider the choice of treatment modality. If the biopsy rules out BXO as a cause of non-retractile foreskin, then conservative treatment is most likely possible. If, on the other hand, a biopsy confirms the presence of BXO, the choice of treatment modality is more difficult.