Lichen Sclerosus in Pediatric Phimosis: Histopathological Prevalence and Lack of Human Papilloma Virus-Related Koilocytosis

Background: Lichen sclerosus (LS), also known as balanitis xerotica obliterans (BXO) when affecting the male genitalia, is a chronic inflammatory dermatosis that can involve the foreskin and glans penis. LS is a chronic inflammatory condition affecting the male genitalia that may lead to progressive preputial fibrosis and pathological phimosis. The etiology of this condition remains unclear, and its relationship with viral infections is still debated, particularly in pediatric populations. The aim of this study was to evaluate the incidence of LS in foreskin specimens obtained during circumcision for phimosis and to assess the presence of koilocytic changes suggestive of human papilloma virus (HPV) infection. Methods: An observational descriptive study was conducted in pediatric patients undergoing circumcision for phimosis between January 2021 and May 2021 at a tertiary pediatric hospital. Clinical variables included age, type of phimosis according to the Kayaba classification, and clinical suspicion of balanitis xerotica obliterans prior to surgery. All patients underwent circumcision, and foreskin specimens were systematically sent for histopathological examination. The pathological analysis evaluated the presence of LS and koilocytic changes. Statistical analysis included Student’s t-test for continuous variables and chi-square or Fisher’s exact test for categorical variables, considering a p-value lower than 0.05 as statistically significant. Results: Twenty-six patients were initially included in the study. Two cases were excluded because of incomplete clinical information, leaving a final sample of 24 patients. The mean age was seven years, with a range between 1 and 15 years. All patients presented with Kayaba type I phimosis. Histopathological examination revealed LS in 11 cases (45.8%), while the remaining 13 specimens (54.2%) showed nonspecific chronic inflammatory changes. Clinical suspicion of BXO prior to surgery was documented in seven patients (29.2%), and histopathological confirmation was observed in all of these cases. Additionally, LS was identified histologically in four patients (16.7%) without previous clinical suspicion. This difference between clinical suspicion and histopathological diagnosis was statistically significant (p = 0.01). No cases demonstrated koilocytic changes suggestive of HPV infection. Conclusions: Lichen sclerosus is a relatively frequent histopathological finding in pediatric patients undergoing circumcision for phimosis, even when clinical suspicion is absent. Routine histopathological examination of foreskin specimens may help identify subclinical disease. In this series, no association was identified between LS and koilocytic changes suggestive of HPV infection. Further studies are necessary to clarify the etiological factors involved in LS and its potential relationship with viral infections.