Epidemiology
The true prevalence of Balanitis xerotica obliterans is controversial and unclear. One study calculated a rate of 0.6% of boys are affected by their 15th birthdays. Another reported a rate of 0.07%. However, a review noted that "with a high degree of suspicion and histologic examination, the condition will prove to be much more frequent than one generally believes." Another suggested that "more cases would be diagnosed during infancy if all dried foreskin were examined systematically." Another remarked that the condition "may be misdiagnosed or ignored in the young boy." Yet another commented that "its true incidence is not appreciated because most cases are cured by circumcision, and unfortunately many surgeons still fail to send their circumcision specimens for histology." Another remarked that the "extent of asymptomatic disease in this series would suggest the true prevalence of LS in men might be much higher than published work suggests."
According to some authors, the disease most frequently affects middle-aged men. However, a large study reported that the age distribution was similar from 2 to 90 years of age, except for men in their twenties, who were at twice the risk. The same study found that black and Hispanic men had approximately twice the risk of white men. The authors suggested possible reasons for this, including access to health care, differences in neonatal circumcision rates, and climate differences.
Mallon et al. found that Balanitis xerotica obliterans was related to circumcision status. Adjusting for age, lack of circumcision was associated with an odds ratio of 53.55. The finding was statistically significant. However, Balanitis xerotica obliterans has also been noted to occur after late circumcision, especially when performed for phimosis.
Read more about this topic: Balanitis Xerotica Obliterans