Burning sensation - Will CO2 laser to treat Balanitis Xerotica Obliterans on the glans? (Photo)

Question

Hello, I was officially diagnosed with BXO after seeing several Urologists and trying several corticosteroids creams. I developed BXO 2 years ago. It is located only on the left side of the glans and has left a large gray patch. I am also experiencing burning pain that worsens in the evening. Other times, my skin feels like it is bruised. I was circumcised back in June 2025 which resolved the redness and reduced some of the pain. Unfortunately, I still have persistent pain from the BXO. Can I try CO2 laser or even surgery with a skin graft? What options do I have for BXO- Post Circumcision? I am currently treating it with Zoryve once daily by my Dermatologist, but I am still in pain after 5 months of use. I want to be able to move on from this and live a normal life. Is a skin graft a more permanent solution or should I try CO2 destruction of the penile lesion first? Can laser worsen the condition or make my pain increase? I want to no longer feel the burning pain. I am willing to try anything to bring remission. Thank you for your help.

Erik Peterson, MD · Answer

BXO (penile lichen sclerosus) is a chronic inflammatory skin condition that often responds best to medical therapy first, not immediately to cutting or lasers. The mainstay is potent topical corticosteroids like clobetasol, sometimes with tacrolimus or other treatments if steroids alone don’t control symptoms. Many people improve with ongoing medical therapy, but it’s not a guaranteed cure. 
CO₂ laser has been used in some cases to vaporize BXO lesions when conservative treatments fail, and there are case series reporting remission after a few sessions, but it’s not considered a standard therapy and can carry a risk of scarring or worsening symptoms if not done carefully by someone experienced. The evidence for it is limited. 
A skin graft or surgical excision is generally considered when there is significant scarring, urethral involvement, or refractory disease that interferes with function or quality of life, not just for cosmetic relief. Grafting with normal tissue (for example buccal mucosa inside the mouth) may be chosen in complex reconstructions because using diseased genital skin has a higher risk of recurrence. 
Because BXO is chronic and can extend beneath the surface of what you see, it’s really important to have this evaluated in person by someone experienced with lichen sclerosus of the penis, like a board‑certified dermatologist or urologist who treats genital skin conditions. They can assess whether what you’re feeling now is active inflammation, scar tissue, or something else, and guide whether laser, further surgery, or continued medical therapy is appropriate for you.
If pain is your primary issue despite circumcision and topical therapy, that’s a good reason to ask a specialist about whether additional options like intralesional steroids, nerve‑modulating pain management, or targeted procedures might help before jumping straight to aggressive options.

Burning sensation - Will CO2 laser to treat Balanitis Xerotica Obliterans on the glans? (Photo)

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