Management of phimosis in adolescents during puberty primarily involves conservative approaches initially, as physiological phimosis is common and often resolves spontaneously with time and puberty.
Good hygiene should be advised, including gentle daily washing with lukewarm water without forcibly retracting the foreskin if it remains non-retractable, to prevent balanitis and secondary infections 1.
Topical corticosteroids, such as 1% hydrocortisone cream applied once daily for up to 14 days, are recommended as a first-line treatment to reduce inflammation and facilitate foreskin retraction in cases of symptomatic or persistent phimosis 1. This approach is supported by evidence indicating that topical steroids can be effective in resolving phimosis without surgery (Dobanovacki et al., 2012).
If there is suspicion of underlying lichen sclerosus or if phimosis is persistent, recurrent, or associated with recurrent balanitis despite conservative management, referral to a paediatric urologist or surgeon is advised for further assessment and consideration of circumcision 1.
Surgical intervention, such as circumcision, is reserved for cases where medical management fails or when there are complications like severe lichen sclerosus or recurrent infections 1.
Overall, the management strategy balances watchful waiting and conservative topical treatment during puberty, reserving surgery for refractory or complicated cases, consistent with both UK guidelines and paediatric urology literature (Dobanovacki et al., 2012).