The quality of evidence is downgraded by study limitations (unclear allocation concealment and blinding), and by inconsistency (unexplained variability in results).
A Cochrane review included 12 studies with a total of 1 395 boys aged from 18 days to 17 years. Corticosteroids used in the intervention groups were betamethasone, mometasone furoate, beclomethasone dipropionate, hydrocortisone butyrate, triamcinolone, and clobetasol propionate. Most of the studies used an aqueous cream or vaseline as the control group; one study used manual retraction. Most studies used manual retraction of the foreskin as a co-intervention in both the intervention and the control groups. Treatment duration varied from 4 to 8 weeks. Compared with placebo, corticosteroids significantly increased complete or partial clinical resolution of phimosis (table ). Although 9 studies (n=978) reported that assessment of adverse effects were planned in the study design, these outcomes were not reported.
| Outcome | Relative effect (95% CI) | Assumed risk - Control | Corresponding risk - Steroids (95% CI) | Participants (studies) |
|---|---|---|---|---|
| * statistical heterogeneity I2=79%; ** statistical heterogeneity I2=78% | ||||
| Resolution of phimosis (complete or partial) | RR 2.45 (1.84 to 3.26)* | 343 per 1000 | 840 per 1000 (631 to 1000) | 1 395 (12) |
| Complete resolution of phimosis | RR 3.42 (2.08 to 5.62)** | 183 per 1000 | 626 per 1000 (381 to 1000) | 858 (8) |
| Any adverse effects | RR 0.0 (0.0 to 0.0) | 0 per 1000 | 0 per 1000 (0 to 0) | 978 (9) |
| Re-stenosis (6 months) | RR 1.50 (0.29 to 7.73) | 133 per 1000 | 199 per 1000 (38 to 1000) | 30 (1) |
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