Zoon's balanitis

Jump to: navigation, search

WikiDoc Resources for Zoon's balanitis

Articles

Most recent articles on Zoon's balanitis

Most cited articles on Zoon's balanitis

Review articles on Zoon's balanitis

Articles on Zoon's balanitis in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Zoon's balanitis

Images of Zoon's balanitis

Photos of Zoon's balanitis

Podcasts & MP3s on Zoon's balanitis

Videos on Zoon's balanitis

Evidence Based Medicine

Cochrane Collaboration on Zoon's balanitis

Bandolier on Zoon's balanitis

TRIP on Zoon's balanitis

Clinical Trials

Ongoing Trials on Zoon's balanitis at Clinical Trials.gov

Trial results on Zoon's balanitis

Clinical Trials on Zoon's balanitis at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Zoon's balanitis

NICE Guidance on Zoon's balanitis

NHS PRODIGY Guidance

FDA on Zoon's balanitis

CDC on Zoon's balanitis

Books

Books on Zoon's balanitis

News

Zoon's balanitis in the news

Be alerted to news on Zoon's balanitis

News trends on Zoon's balanitis

Commentary

Blogs on Zoon's balanitis

Definitions

Definitions of Zoon's balanitis

Patient Resources / Community

Patient resources on Zoon's balanitis

Discussion groups on Zoon's balanitis

Patient Handouts on Zoon's balanitis

Directions to Hospitals Treating Zoon's balanitis

Risk calculators and risk factors for Zoon's balanitis

Healthcare Provider Resources

Symptoms of Zoon's balanitis

Causes & Risk Factors for Zoon's balanitis

Diagnostic studies for Zoon's balanitis

Treatment of Zoon's balanitis

Continuing Medical Education (CME)

CME Programs on Zoon's balanitis

International

Zoon's balanitis en Espanol

Zoon's balanitis en Francais

Business

Zoon's balanitis in the Marketplace

Patents on Zoon's balanitis

Experimental / Informatics

List of terms related to Zoon's balanitis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Vishal Devarkonda, M.B.B.S[2]

Synonyms and Keywords: ZB, Plasma cell balanitis

Overview

Zoon's balanitis is a rare non-veneral idiopathic chronic benign inflammatory mucositis of genitalia. In 1952, for the first time in medical literature, Zoon recognized a distinct entity in patients with chronic balanitis,and named it has balanoposthite chronique circonscrite bénigne á plasmocytes or balanitis chronica circumscripta plasmacellularis.[1] The exact pathogenesis of Zoon's balanitis is not clearly known. Patients with Zoon's balanitis presents with well circumscribed single or multiple orange-red in colour lesions with characteristic glazed appearance and multiple pinpoint redder spots "cayenne pepper spots" most commonly involving glans penis. Diagnosis of Zoon's balanitis is confirmed by biopsy. Management of Zoon's balanitis includes both medical and surgical modalities.

Historical Perspective

  • In 1952, for the first time in medical literature, Zoon recognized a distinct entity in patients with chronic balanitis, named it has balanoposthite chronique circonscrite bénigne á plasmocytes” or “balanitis chronica circumscripta plasmacellularis.[1]
  • In 1954, Garnier reported similar lesions in vulva.[2]
  • In 1956, Nikolowski described identical lesions in oral mucosa.[3]
  • In 1963, Kortnig described idential lesions in conjunctiva.[4]

Classification

There is no established classification system for Zoon's balanitis.

Pathophysiology

Pathogenesis

The exact pathogenesis of Zoon's balanitis is not clearly known, but following theories have been postulated:[5]

Histopathology

Zoon's balanitis has distinctive histopathological features, which include:[7]

Epidermal

Dermal

Epidemiology and Demographics

There are no comprehensive studies studying the epidemiology and demographics of Zoon's disease in general population. A recent study has reported that out of 226 patients examined in a genitourinary medicine clinic over a period of 3 years, about 26(10%) of patients were diagnosed with Zoon's balanitis.[8]

Screening

There is no established screening guidelines for Zoon's balanitis.

Natural History, Complications, and Prognosis

Natural history

If left untreated, patients with Zoon's balanitis may develop pain, phimosis and paraphimosis. Studies have reported that there could be an increased risk of transformation of these lesions into squamous cell carcinoma.[9]

Complications

Complications of Zoon's balanitis include:

Prognosis

Prognosis is usually good with treatment.[10]

Diagnosis

History and symptoms

Patients with Zoon's balanitis could present with asymptomatic or symptomatic lesions with:[11]

Physical examination

Characteristic lesions seen in Zoon's balanitis are:[6][12]

Clinical criteria for diagnosing Zoon's balanitis include the following:[12]

Laboratory findings

Laboratory findings in Zoon's balanitis include:[14][15]

Reflectance confocal microscopy

A nucleated honeycomb pattern and vermicular vessels is a clue for benign inflammatory genital skin disease

Dermoscopy

Focal/diffuse orange-yellowish structure with fewer areas representing hemosiderin deposition and curved vessels due to epidermal thinning help in distinguishing ZB from carcinoma in situ.

Biopsy

Epidermis

Epidermal thickening which is followed by epidermal atrophy, at times with erosions

Dermis

Plasma cell infiltrate with haemosiderin and extravasated red blood cells.

Treatment

Management of Zoon's balanitis includes general measures, medical and surgical modalities:[16][17][18]

General measures

Good hygiene which include retracting the foreskin regularly and gentle cleansing of entire glans, preputial sac, and foreskin were found effective in treating Balanitis in general.[17]

Medical Therapy

Medical modalities for treating Zoon's balanitis
Drugs Drug dosage
Topical steroids Saline compresses containing 1% hydrocortisone/0.02% betamethasone+/-17-valerate/0.05% betamethasone dipropionate
Oxytetracycline 3%, nystatin 100,00(units/g), and clobetasone butyrate 0.05% applied until complete resolution was observed
Topical calcineurin Tacrolimus ointment 0.1% twice daily
Topical Pimecrolimus Pimecrolimus cream 1% twice daily
Topical Imiquimod 5% imiquimod cream, 3 times a week for 4 months with multiple periods without treatment
5% imiquimod cream, 3 times a week for 12 months without any interruption

Surgery

Surgical modalities for treating Zoon's balanitis
Procedure Follow-up
Circumcision Lesion disappear by 5-6 weeks after procedure, with no relapse observed
Carbon dioxide laser Complete resolution in 3 months, with no relapse observed in following 5 years of follow up
Yag laser Complete clearance is seen patients within 2-3 weeks, with no relapse observed in following 30 months of follow up
PDT(Photodynamic therapy) Lesion healed completely after an average 2.75 PDT sessions, with no relapse observed in following 1 year of follow up

Prevention

Primary Prevention

There is no established primary prevention measures for preventing of Zoon's balanitis.

Secondary prevention

There is no established secondary prevention measures for Zoon's balanitis.

References

  1. 1.0 1.1 ZOON JJ (1952). "[Chronic benign circumscript plasmocytic balanoposthitis]". Dermatologica. 105 (1): 1–7. PMID 12979576.
  2. Sonnex TS, Dawber RP, Ryan TJ, Ralfs IG (1982). "Zoon's (plasma-cell) balanitis: treatment by circumcision". Br J Dermatol. 106 (5): 585–8. PMID 7073984.
  3. NIKOLOWSKI W, WIEHL R (1956). "[Not Available]". Arch Klin Exp Dermatol. 202 (4): 347–57. PMID 13340789.
  4. KORTING GW, THEISEN H (1963). "[CIRCUMSCRIBED PLASMA CELL BALANOPOSTHITIS AND CONJUNCTIVITIS IN THE SAME PATIENT]". Arch Klin Exp Dermatol. 217: 495–504. PMID 14098119.
  5. Porter WM, Bunker CB (2001). "The dysfunctional foreskin". Int J STD AIDS. 12 (4): 216–20. PMID 11319970.
  6. 6.0 6.1 Pastar Z, Rados J, Lipozencić J, Skerlev M, Loncarić D (2004). "Zoon plasma cell balanitis: an overview and role of histopathology". Acta Dermatovenerol Croat. 12 (4): 268–73. PMID 15588560.
  7. Weyers W, Ende Y, Schalla W, Diaz-Cascajo C (2002). "Balanitis of Zoon: a clinicopathologic study of 45 cases". Am J Dermatopathol. 24 (6): 459–67. PMID 12454596.
  8. Pearce J, Fernando I (2015). "The value of a multi-specialty service, including genitourinary medicine, dermatology and urology input, in the management of male genital dermatoses". Int J STD AIDS. 26 (10): 716–22. doi:10.1177/0956462414552695. PMID 25294843.
  9. 9.0 9.1 Dayal S, Sahu P (2016). "Zoon balanitis: A comprehensive review". Indian J Sex Transm Dis. 37 (2): 129–138. doi:10.4103/0253-7184.192128. PMC 5111296. PMID 27890945.
  10. Dayal S, Sahu P (2016). "Zoon balanitis: A comprehensive review". Indian J Sex Transm Dis. 37 (2): 129–138. doi:10.4103/0253-7184.192128. PMC 5111296. PMID 27890945.
  11. Edwards SK, Bunker CB, Ziller F, van der Meijden WI (2014). "2013 European guideline for the management of balanoposthitis". Int J STD AIDS. 25 (9): 615–26. doi:10.1177/0956462414533099. PMID 24828553.
  12. 12.0 12.1 Kumar B, Narang T, Dass Radotra B, Gupta S (2006). "Plasma cell balanitis: clinicopathologic study of 112 cases and treatment modalities". J Cutan Med Surg. 10 (1): 11–5. PMID 17241566.
  13. Adégbidi H, Atadokpèdé F, Dégboé B, Saka B, Akpadjan F, Yédomon H; et al. (2014). "[Zoon's balanitis in circumcised and HIV infected man, at Cotonou (Benin)]". Bull Soc Pathol Exot. 107 (3): 139–41. doi:10.1007/s13149-014-0359-4. PMID 24792459.
  14. Arzberger E, Komericki P, Ahlgrimm-Siess V, Massone C, Chubisov D, Hofmann-Wellenhof R (2013). "Differentiation between balanitis and carcinoma in situ using reflectance confocal microscopy". JAMA Dermatol. 149 (4): 440–5. doi:10.1001/jamadermatol.2013.2440. PMID 23325422.
  15. Errichetti E, Lacarrubba F, Micali G, Stinco G (2016). "Dermoscopy of Zoon's plasma cell balanitis". J Eur Acad Dermatol Venereol. 30 (12): e209–e210. doi:10.1111/jdv.13538. PMID 26670716.
  16. Dayal S, Sahu P (2016). "Zoon balanitis: A comprehensive review". Indian J Sex Transm Dis. 37 (2): 129–138. doi:10.4103/0253-7184.192128. PMC 5111296. PMID 27890945.
  17. 17.0 17.1 Edwards SK, Bunker CB, Ziller F, van der Meijden WI (2014). "2013 European guideline for the management of balanoposthitis". Int J STD AIDS. 25 (9): 615–26. doi:10.1177/0956462414533099. PMID 24828553.
  18. Pinto-Almeida T, Vilaça S, Amorim I, Costa V, Alves R, Selores M (2012). "Complete resolution of Zoon balanitis with photodynamic therapy--a new therapeutic option?". Eur J Dermatol. 22 (4): 540–1. doi:10.1684/ejd.2012.1779. PMID 22693017.