Phimosis is the complete or partial inability to retract the foreskin over the glans. Usually, it is a physiological condition, present from birth, and in the majority of cases resolves with variable timing during growth. Pathological phimosis occurs when the failure to retract the foreskin is caused by a distal scar tissue, secondary to recurrent balanoposthitis, trauma, or balanitis xerotica obliterans. The physiological and asymptomatic forms should not be treated as they tend to resolve spontaneously, while treatment should be reserved for its pathological or symptomatic forms, in case of balanoposthitis or recurrent urinary infections, paraphimosis and symptomatic vesicoureteral reflux or hydroureteronephrosis. This article analyses the previous studies on the use of topical steroids in the treatment of phimosis. The literature shows their high rate of efficacy in improving or resolving this condition, without significant differences between low-medium and high-potency steroids, and the absence of adverse effects. Therefore, the use of topical steroids in the distal stenotic portion of the foreskin, applied for a month (and possibly repeatable), is an optimal strategy in the initial management of phimosis, reserving surgery (circumcision) as a second-line treatment in case of failed conservative therapy.