Balanitis xerotica obliterans (BXO) is a form of lichen sclerosus (LS) that affects the penis. This autoimmune inflammatory disorder can lead to significant morbidity because of scarring and urinary and sexual discomfort.
A 60-year-old circumcised man presented with an 8-month history of a gradually worsening painful lesion on his penis. He had previously been treated for several months with clobetasol and tacrolimus ointments. On physical examination, the shaft and coronal sulcus of the penis demonstrated significant erythema, erosions, crusting, and atrophic scarring (Figure 1). The findings on biopsy were consistent with BXO.