Evaluation of topical corticosteroids in children with phimosis through morphological and immunohistochemical analyses of the foreskin

Abstract

Introduction: Histopathological analysis of the foreskin has become more common in the last two decades.

Objectives: This study aims to analyze the morphology of the foreskin and determine the effects of topical corticosteroid therapy on this tissue.

Materials and methods: We retrospectively evaluated forty foreskin samples from children aged from 2 years to 15 years with phimosis undergoing circumcision at our institution over a 2-year period. In the foreskin samples, we analyzed the elastic fibers (Verhoeff), epidermal thickness (hematoxylin and eosin), and Annexin 1 and Langerhans cells (LCs) (immunohistochemistry).

Results: In the present study, 18 (45%) patients made use of topical corticosteroids, and 22 (55%) did not, while 4 (10%) had a history of balanoposthitis as previous complication. Forty patients were divided according to the parameter analyzed: with or without previous complication and with or without previous topical corticotherapy. Annexin 1 expression was significantly higher in group with a history of complications when compared with group without complications (P = 0.024) and lower in the group of those who used corticosteroids when compared with those who did not used corticosteroids (P = 0.364). In the analysis of all samples, the density of mature LCs was significantly higher when compared with immature LCs (P < 0.0001). The density of immature LCs was significantly higher in patients without previous complications when compared with group with complications (P = 0.028).

Conclusions: These findings contribute to a better understanding of the histopathological aspects of previous complications and of treatment with corticosteroids in children with phimosis.

Keywords: Annexin 1; Langerhans cells; corticosteroids; phimosis.

Figure 1

Analysis of the foreskin in pediatric patients undergoing surgery for circumcision. (a) Comparison of the number of elastic fibers between groups with and without previous complications (balanoposthitis). (b) Comparison of the epidermal thickness in three areas of the foreskin. Significant differences: Middle foreskin versus other groups. (c) Comparison of the amount of Annexin between groups with and without previous complications (balanoposthitis). (d) Density of mature Langerhans cells and immature Langerhans cells in samples of foreskin. The error bars represent the standard deviation