Topical corticosteroids for treating primary phimosis in children: An evidence-based review

Abstract

Goals: Phimosis is defined as the presence of a non-retractable foreskin by a narrow preputial ring. It can be classified as primary or secondary. Primary phimosis is present in 96% of newborns, and tends to resolve spontaneously in the first 3 years of life. After this age treatment may be considered. Circumcision is the classic treatment, but is associated with morbidity and costs. Recently, several authors have reported the use of topical steroids as an alternative treatment for phimosis with good results. The aim of this review is to evaluate the available evidence on the efficacy and safety of topical steroids in the treatment of primary phimosis in children aged 3 to 18 years. Data sources:Medline, evidence-based medicine web sites, the Index of Portuguese Medical Journals and references of selected articles. Review methods: Practice guidelines, systematic reviews, meta-analyses and randomized controlled trials (RCT) were searched using the keywords phimosis and steroids. The Strength of Recommendation Taxonomy (SORT) of the American Family Physician was used to classify the articles. Results: Forty four articles were found and four met the inclusion criteria for this review. One guideline proposes treatment with a topical steroid, 0,05% to 0,1%, twice a day for 20 to 30 days (SOR A). Three randomized controlled trials found that the use of topical steroids in the treatment of primary phimosis is effective, with a resolution rate of 65,8% to 90% and no reported adverse effects (evidence level 1). Conclusions: The available evidence suggests that the use of topical steroids for the treatment of primary phimosis in pediatric patients is effective and without adverse effects (SOR A). The application of the drug requires retraction of the foreskin, which must be repeated for maintaining hygiene. Topical steroids are safe and effective for the treatment of phimosis and can be recommended by the Family Physician.