Topical oestrogen induces keratinisation of human inner foreskin whilst langerhans cell distribution remains unaffected- implications for HIV prevention.

Abstract

AIM: To determine epithelial thickness and Langerhans cell distribution of the inner foreskin, in comparison to the remnant foreskin and penile shaft skin, and evaluate the potential of topical oestrogen to reduce the risk of HIV infection in males through increased keratinisation of the inner foreskin. METHOD: 50 men were recruited from the Austin Hospital. 10 patients had biopsies of their remnant foreskin and penile shaft skin taken at the time of vasectomy. 30 men applied oestrogen cream or placebo to their inner foreskin for a period of two weeks prior to circumcision, whilst 10 men received no treatment prior to circumcision. Foreskin epithelial biopsies were collected both before and after treatment. The thickness of the epithelium and keratin was measured, and the number of Langerhans cells/mm2. RESULTS: There was no significant difference in epithelial or keratin thickness between the inner foreskin, remnant foreskin or shaft skin. There were significantly fewer Langerhans cells in the remnant foreskin compared to the inner foreskin and penile shaft skin, and significantly more Langerhans cells in the inner foreskin than the penile shaft skin. Topical oestrogen causes a significant increase in keratin thickness, however it does not significantly change the number of distribution of Langerhans cells.