Doctors miss rare skin disease in most boys with tight foreskin

<p>Background Male genital lichen sclerosus is a relatively uncommon but increasingly recognized cause of phimosis in paediatric patients. Objectives To investigate the presence of male genital lichen sclerosus (MGLS) in paediatric patients presenting with phimosis and to evaluate the diagnostic accuracy of clinical assessment compared with histopathological findings. Methods We conducted a single-centre, retrospective study of 48 paediatric circumcisions performed for phimosis over an 18-month period. Clinical diagnoses of phimosis were categorized as physiological or pathological and compared with postoperative histopathological findings. To quantify diagnostic reliability, percentage agreement and Cohen’s kappa coefficient were used. Results MGLS was confirmed histologically in 71% of patients, with the highest proportion occurring in boys aged 9–11 years. Among those clinically diagnosed with physiological phimosis, 70% showed histological evidence of MGLS, of whom 48% exhibited extensive disease. The overall concordance between clinical and histological diagnoses was 43.75%, with a Kappa value of 0.027, indicating only slight agreement. Conclusions Currently, clinical assessments seem to underestimate the proportion of cases with MGLS, especially among younger boys. Enhancing awareness and recognition of this condition is essential to facilitate accurate and timely diagnosis, and to guide appropriate interventions, thereby preventing disease progression and reducing associated morbidity.</p>