Balanitis Xerotica Obliterans Successfully Treated with Topical Tacrolimus: A Case Report and Literature Review

Balanitis xerotica obliterans (BXO) is a chronic, progressive, inflammatory, and sclerosing disease of the male genitalia. If left untreated, it can lead to urinary and sexual dysfunction and reduced quality of life. We describe a 15-year-old Caucasian male with a 3-month history of progressive thickening and whitening of the prepuce and penile glans. He reported mild pruritus, embarrassment of the prepuce retraction, painful cracking of the foreskin, and painful erection. Dermatological examination showed mild erythema and hypopigmentation of the foreskin and penile glans, a sclerotic white ring, and erosions at the distal portion of the prepuce. Based on history and clinical findings, a final diagnosis of balanitis xerotica obliterans was made. Topical treatment with miconazole nitrate/hydrocotison 20mg/10mg/g cream (Daktacort) - once a day for 3 months and topical tacrolimus 0.03% ointment (Protopic) - once a day for 3 months, twice daily for 9 months, and once a day for 4 months was applied, resulting in gradual and fully improvement of the subjective and objective manifestations of the disease. No side effects were observed. Our findings are consistent with published data and further support the recommendation for topical tacrolimus as a therapeutic option for BXO.