Letter to the Editor: Comorbidities in Male Patients With Lichen Sclerosus: A Case-Control Study

We read with great interest the article by Hieta et al., which examines comorbidities in male patients with lichen sclerosus (LS), emphasizing its chronic inflammatory nature and potential for malignant transformation, particularly into penile squamous cell carcinoma and carcinoma in situ. Chronic inflammation, oxidative stress, and the overexpression of p53 and Ki67 suggest a progression toward neoplastic changes. Notably, pediatric LS exhibits similar immune and proliferative patterns, underlining the need for early diagnosis and long-term follow-up. Immune responses involving CD8 and CD57 cells appear to play a key role in disease progression. The current standard treatment circumcision for foreskin-confined cases and topical corticosteroids can effectively manage symptoms but carries risks with prolonged use, including skin atrophy and increased susceptibility to HPV infections. Hieta et al. report HPV DNA in 22% of LS cases, although its exact role in pathogenesis remains unclear. These concerns highlight the need for safer therapeutic options. One such alternative is Ozoile, a stable ozonide derived from extra virgin olive oil through green technology. Ozoile promotes tissue regeneration and modulates inflammation via NRF2 activation, offering a non-immunosuppressive alternative to corticosteroids. We commend Hieta et al. for their valuable contribution and stress the importance of tailored treatment approaches, vigilant monitoring, and early intervention, especially in LS cases associated with phimosis.