E-Mail karger@karger.com Letter to the Editor Urol Int 2017;98:111 DOI: 10.1159/000449017 Polydeoxyribonucleotide Treatment in Genital Lichen Sclerosus in Males Salvatore Arena Carmelo Romeo Department of Human Pathology in Adult and Developmental Age ‘Gaetano Barresi’, Unit of Paediatric Surgery, University of Messina, Messina, Italy Treatment with Polydeoxyribonucleotide’ [1]. The article focuses on the role and ef- fects of polydeoxyribonucleotide (PDRN) in the treatment of a genital lichen sclerosus in males and the authors not- ed a significant improvement of overall conditions of treated patients [1]. In pre- vious studies, we studied the action of PDRN in model of testicular ischemia/re- perfusion [2] injury and varicocele as well and we documented that PDRN has po- tent cytoprotective effects by inducing VEGF and modulating the apoptotic mechanism [3, 4]. Furthermore, PDRN activated neoangiogenesis, which amelio- rates the blood supply and oxygenation [5]. We believe that PDRN can also act in a similar fashion in human lichen sclero- sus. In our experience, the incidence of li- chen sclerosus in paediatric patients who Key Words Polydeoxyribonucleotide · Lichen sclerosus · Balanitis xetotica obliterans Abstract It has been reported that treatment with polydeoxyribonucleotide (PDRN) in males affected by lichen sclerosus significantly im- proves the overall conditions of treated pa- tients. It confirms that PDRN has a potent cy- toprotective action as in other pathological conditions. We believe that multicentric ran- domized clinical trials are necessary for test- ing the benefits of this promising agent. © 2016 S. Karger AG, Basel We read and appreciated very much the article written by Zucchi et al. ‘Genital Li- chen Sclerosus in Male Patients: A New Received: July 26, 2016 Accepted after revision: August 8, 2016 Published online: September 13, 2016 Dr. Salvatore Arena Department of Human Pathology in Adult and Developmental Age ‘Gaetano Barresi’ Unit of Paediatric Surgery, University of Messina Viale Gazzi – AUO ‘Gaetano Martino’, IT–98124 Messina (Italy) E-Mail salarena  @  unime.it © 2016 S. Karger AG, Basel www.karger.com/uin underwent circumcision for secondary phimosis is about 45% and, at the mo- ment, we have been treating them with steroids. However, steroids treatment can cause side effects, even leading to serious outcome, and sometimes it is contraindi- cated (i.e. diabetes). On the basis of the above research, we believe that treatment of lichen sclerosus with PDRN can be an intriguing alternative to steroids. A limita- tion, mostly in paediatric age, might be the application of intra-dermal or submuco- sal injection of PDRN and, as is well known that children do not tolerate nee- dles well. We are considering the possibil- ity that PDRN cream (Turnover © , Mas- telli S.r.l., Sanremo, Italy) could be used with the same results. We believe that multicentric randomized clinical trials are necessary for testing the benefits of this promising agent. Internationalis Urologia References 1 Zucchi A, Cai T, Cavallini G, D’Achille G, Pastore AL, Franco G, Lepri L, Costantini E: Genital lichen sclerosus in male patients: a new treatment with polydeoxyribonucleo- tide. Urol Int 2016; 97: 98–103. 2 Minutoli L, Antonuccio P, Squadrito F, Bitto A, Nicotina PA, Fazzari C, Polito F, Marini H, Bonvissuto G, Arena S, Morgia G, Romeo C, Caputi AP, Altavilla D: Effects of polydeoxy- ribonucleotide on the histological damage and the altered spermatogenesis induced by testicular ischaemia and reperfusion in rats. Int J Androl 2012; 35: 133–144. 3 Minutoli L, Arena S, Bonvissuto G, Bitto A, Polito F, Irrera N, Arena F, Fragalà E, Romeo C, Nicotina PA, Fazzari C, Marini H, Implat- ini A, Grimaldi S, Cantone N, Di Benedetto V, Squadrito F, Altavilla D, Morgia G: Activa- tion of adenosine A2A receptors by poly- deoxyribonucleotide increases vascular en- dothelial growth factor and protects against testicular damage induced by experimental varicocele in rats. Fertil Steril 2011; 95: 1510– 1513. 4 Minutoli L, Arena S, Antonuccio P, Romeo C, Bitto A, Magno C, Rinaldi M, Micali A, Irrera N, Pizzino G, Galfo F, Squadrito F, Altavilla D, Marini H: Role of inhibitors of apoptosis proteins in testicular function and male fertility: effects of polydeoxyribo- nucleotide administration in experimental varicocele. Biomed Res Int 2015; 2015: 248976. 5 Arena S, Minutoli L, Arena F, Nicotina PA, Romeo C, Squadrito F, Altavilla D, Morgia G, Magno C: Polydeoxyribonucleotide adminis- tration improves the intra-testicular vascular- ization in rat experimental varicocele. Fertil Steril 2012; 97: 165–168. Downloaded by: Univ. of California San Diego 132.239.1.231 - 5/5/2017 2:44:23 AM