Long-term monitoring needed for lichen sclerosus

We read with great interest the article titled “Foreskin care. Hygiene, importance of counselling, and management of common complications” by Leeson et al, in the February 2025 issue of Canadian Family Physician. We sincerely commend the authors for their comprehensive and insightful overview of foreskin development, care, and management that provides an invaluable resource for clinicians in the field. We would like to highlight certain aspects regarding the treatment of lichen sclerosus (LS) that warrant further discussion in light of recent developments in the field. The article acknowledges the role of routine foreskin hygiene in reducing the risk of pathologic phimosis and LS, as well as the proven efficacy of topical corticoste roids, particularly clobetasol propionate 0.05%, as a first line treatment. However, while corticosteroids may offer symptomatic relief and transient improvement in foreskin retractability, concerns about long-term safety remain. Adverse effects such as skin atrophy, striae formation, and the recurrence of viral infections like human papillo mavirus have been documented. These concerns, stem ming from a lack of extensive long-term studies, highlight the need for alternative, safer treatment options. Building on this excellent review, we would like to contribute by highlighting additional perspec tives on emerging treatment options. Alternative ther apies, including topical calcineurin inhibitors such as tacrolimus and pimecrolimus, have shown promise in treating LS without atrophogenic effects due to their anti inflammatory and immunomodulatory properties. Innovative treatments like a stable ozonide derived from extra virgin olive oil through a patented process (Ozoile) have shown potential in promoting tissue regeneration and modulating inflammation through nuclear factor erythroid 2-related factor 2 activation, offering a non immunosuppressive option for managing LS and other dermatologic and inflammatory conditions.The increased risk of penile squamous cell carcinoma and carcinoma in situ in patients with LS emphasizes the need for vigilant, long-term follow-up starting at an early age.4 The immune and proliferative behaviour of pediatric LS mirrors that of adult cases,4 with chronic inflammation, oxidative stress, and p53 tumour suppres sor protein overregulation contributing to the neoplastic potential of LS. Recent studies emphasize the impor tance of circumcision remaining the definitive treatment in 96% of LS cases and that its role alongside adjunctive medical therapy deserves greater attention. We again express our appreciation to the authors for the well-researched contribution to this important topic. Their work provides essential guidance for clinicians managing foreskin-related conditions, and we hope further research will continue to expand the therapeutic landscape for LS