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Circumcision and Genital Dermatoses
Eleanor Mallon, MRCP;
David Hawkins, FRCP;
Michael Dinneen, FRCS;
Nicholas Francis, FRCPath;
Louise Fearfield, MRCP;
Roger Newson, DPhil;
Christopher Bunker, FRCP
Arch Dermatol. 2000;136:350-354.
Context It is well recognized that the presence of a foreskin predisposes to penile carcinoma and sexually transmitted infections. We have investigated the relationship between the presence or absence of the foreskin and penile dermatoses.
Objective To determine whether there is an association between circumcision and penile dermatoses.
Design A retrospective case control study of patients attending the department of dermatology with genital skin conditions.
Subjects The study population consisted of 357 male patients referred for diagnosis and management of genital skin disease. The control population consisted of 305 male patients without genital skin disease attending the general dermatology clinics over a 4-month period.
Main Outcome Measures The relationship between circumcision and the presence or absence of skin disease involving the penis was investigated. The rate of circumcision in the general male dermatology population was determined.
Results The most common diagnoses were psoriasis (n=94), penile infections (n=58), lichen sclerosus (n=52), lichen planus (n=39), seborrheic dermatitis (n=29), and Zoon balanitis (n=27). Less common diagnoses included squamous cell carcinoma (n=4), bowenoid papulosis (n=3), and Bowen disease (n=3). The age-adjusted odds ratio for all penile skin diseases associated with presence of the foreskin was 3.24 (95% confidence interval, 2.26-4.64). All patients with Zoon balanitis, bowenoid papulosis, and nonspecific balanoposthitis were uncircumcised. Lichen sclerosus was diagnosed in only 1 circumcised patient. Most patients with psoriasis, lichen planus, and seborrheic eczema (72%, 69%, and 72%, respectively) were uncircumcised at presentation. The majority of men with penile infections (84%) were uncircumcised.
Conclusions Most cases of inflammatory dermatoses were diagnosed in uncircumcised men, suggesting that circumcision protects against inflammatory dermatoses. The presence of the foreskin may promote inflammation by a köebnerization phenomenon, or the presence of infectious agents, as yet unidentified, may induce inflammation. The data suggest that circumcision prevents or protects against common infective penile dermatoses.
From the Departments of Dermatology (Drs Mallon, Fearfield, and Bunker), Genitourinary Medicine (Dr Hawkins), Urology (Dr Dinneen), Histopathology (Dr Francis), and Public Health (Dr Newson), Imperial College School of Medicine, Chelsea & Westminster Hospital, London, England.
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