Lichen sclerosus (LS) is a chronic scarring dermatosis of unknown etiology affecting individuals of all races. Lesions occur mostly on the genitalia, perineum, or perianal skin but can appear anywhere.

LS in males, also known as balanitis xerotica obliterans (BXO), may occur in males of all ages and typically involves the glans penis and the inner foreskin in uncircumcised males. Perianal involvement is not typically observed. Patients may report itching and burning, but in the early stages, LS can be asymptomatic.

The etiology is unknown; however, it is more common in uncircumcised males, and exposure to urine may be a factor in the development of LS in males. This is most commonly observed in obese males with urinary microincontinence. It is an uncommon or underreported condition, occurring in less than 1% of males.

Complications of LS include phimosis, painful erections, narrowing of the urinary stream, and diminished force during urination (the latter 2 symptoms may be secondary to urethral stricture formation). LS is less commonly associated with genital squamous cell carcinoma (SCC) than the lesions of vulvar LS. However, it is noted that 25% of penile SCC is associated with LS. Penile melanoma in the setting of LS is rare but has been observed, with penile melanoma accounting for less than 1% of penile cancers.