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Hyperkeratosis of the epidermis (looks like a buildup of eosinophilic keratin flakes on top of the epithelium). Atrophy of the epidermis (look for loss of the rete pegs and overall thinning of the epidermis). Dense homogenized collagenized band beneath the epidermis – looks like a pink glassy material in the superficial subcutaneous tissue (image B), (image C), & (image D).

Treatment: variable response to laser, circumcision, steroids, antifungals, and retinoids (in other words, the verdict is still out on an appropriate therapy). Balanitis xerotica obliterans represents a subset of lichen sclerosus in which there is significant destructive inflammation associated with phimosis and urethral .Balanitis xerotica obliterans BXO , also known as lichen sclerosus of is a dermatological skin condition affecting the male genitalia.
Also known as lichen sclerosus et atrophicus, BXO usually affects older men and may have an autoimmune etiology.

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