The small patchy white spots on the glans and Penile skin may not just be non bothersome depigmentation. It is especially true if accompanied by poor urinary flow rates. These spots or a large patch with itchy areas of dryness may be suggestive of Lichen Sclerosus et atrophicus, a disease with multifactorial origin but poorly defined cause and effect. In affecting the body the disease varies from a mild form of cosmetic depigmentation to Phimosis or scarring of the foreskin to Deformation of the entire urinary pipe ( Pananterior Urethral stricture)leading to the Urinary Bladder inside of the pelvis. It may rarely be Pre Cancerous also ( Less than 3 %). The only way to detect is to observe and diagnose them on time . Initially known with varied names such as Krauses vulvae the disease can be treated medically if detected very early in course of time. The same is done using Emollients, Immunospupressant topical (local)application.
It is far more common in females in the ratio of ten or three times more common than the male. The disease affects the perigenital and anorectal region many times both in a figure of eight pattern. These tend to be common in post menopausal age and is particularly itchy and dry.
There is extra genital affliction in the torso and the nipple region also. The management of the disease is mostly conservative in the form of application of cream and ointments of emmolients and Steroids or Immunosupressants.
The worst case scenario occurs when it affects the whole urethra in the form of a Pan anterior urethral stricture. The patient may have formidable dificulty in passing urine and in very severe cases may be just impossible. In such cases the Patient is diverted or an artificial communication to pass urine is made from the lower part of the Abdomen ( Supra Pubic Catheter)
The final reconstruction of the diseased Urethra is challanging but possible nowadays espacially with the utilization of Buccal Mucosa Urethroplasty. This is so because any other skin tissue used to enlare the urethra is fraught with cent percent failure. In complicated cases two stages procedure may be needed if previously operated. Occasionally if other premorbid conditions exist, such as Pre Renal Transplant status or extreme morbidity Perineal Urethrostomy may be done to allow the patient to void
The same procedures may be used in females albeit in a modified form.
This condition in rarity may be pre cancerous also but presents in livid and florid presentation. These must be diagnosed in time.
All that is white is not RIGHT