Epidermal findings include orthokeratotic hyperkeratosis with follicular plugging, atrophy of the stratum malpighii, hydropic degeneration of the basal layer, and occasional dermal-epidermal clefting. Follicular plugging is not apparent in mucosal lesions. Dermis reveals significant edema and homogenization of the collagen in the upper dermis with dilatation of blood and lymph vessels, and a loss of elastic fibers. An inflammatory infiltrate consisting of lymphoid cells, plasma cells, and histiocytes occurs in the mid-dermis. The inflammatory infiltrate is less pronounced in long-standing lesions.
Circumcision is the traditional treatment method of choice in uncircumcised patients.
Further treatment, or treatment of circumcised patients, is more challenging. Uncircumcised patients usually benefit from therapeutic circumcision. Regularly follow patients to observe any changes in involved areas suggestive of malignancy. Consider surgical intervention for symptoms or signs of urethral meatal stenosis. Consider circumcision by a urologist for symptomatic phimosis or paraphimosis.