Ablative erbium:YAG laser treatment of idiopathic chronic inflammatory non-cicatricial balanoposthitis (Zoon's disease) – A series of 20 patients with long-term outcome

Background: Chronic inflammatory non-cicatricial balanitis/balanoposthitis (Zoon 1952) is not uncommon among aged uncircumcised males. The course is chronic and will lead to severe epidermal atrophy. This disease is poorly responsive to topical treatment. The golden standard for treatment is circumcision. Objective: This study was performed to evaluate the efficacy and safety of ablative erbium:YAG laser treatment. Methods: An uncontrolled trial was performed with 20 Caucasian male patients (mean age 64.8 years) who presented with chronic inflammatory non-cicatricial balanitis or balanoposthitis. The patients received multiple topical treatments. The disease duration ranged from 1 to more than 7 years. Diagnosis was confirmed by histology. Topical anaesthesia was performed before erbium:YAG laser ablation (focus 1.6–5 mm; frequency 8 Hz; impulse energy mostly 800 mJ; fluence between 11.3 and 20 J cm−2). The pulses were partly overlapping. The pain sensation was recorded by visual analogue scale (VAS). Complete clearance was defined as complete absence of erythematous, smooth-faced, 'wet'-looking patches or erosions. Patients were requested to attend a regular follow-up once a year. The outcome was further assessed by patient's global assessment (PGA). Results: In all patients a complete re-epithelialization could be achieved within 2–3 weeks. During follow-up between 3 months and 30 months (mean 12.1 ± 7.2 months), a complete and stable clearing was achieved in 20 patients (100%). There were no severe adverse effects. With topical anaesthetic cream the VAS was very low (mean 1.5 ± 4.1 mm for 18 patients and 22 treatments). All but three patients were 'completely satisfied' with the procedure and the outcome; three were 'satisfied'. Conclusions: Ablative erbium:YAG laser therapy is a safe, effective and minimally invasive treatment option in chronic inflammatory non-cicatricial balanitis/balanoposthitis.