Balanitis: Difference between revisions

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__NOTOC__
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{{DiseaseDisorder infobox |
{{Balanitis}}
  Name          = Balanitis |
{{CMG}}; {{AE}}{{VD}}
  Image          = Balanitis.jpg|
  Caption        = Balanitis Xerotica Obliterans; White Lesions <br> <small> [http://www.peir.net Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology] </small>|
}}
'''For patient information, click [[Balanitis (patient information)|here]]'''


{{SI}}
{{SK}} Balanoposthitis
{{SCC}}


{{SK}} Balanoposthitis


==Overview==
==Overview==
'''Balanitis''' is [[inflammation]] of the [[glans penis]] (from [[Greek language|Greek]]: βάλανος ''balanos'' "acorn"). When the foreskin (or prepuce) is also affected, it is termed ''[[balanoposthitis]]''.
Balanitis is [[inflammation]] of [[glans penis]]. When inflammation involves the [[foreskin]] and [[prepuce]], it is termed as [[balanoposthitis]]. Based on the etiology, balanitis can be mainly categorized into [[Infectious balanitis|infectious]], [[inflammatory dermatoses]], and [[penile carcinoma in situ]]. Patients with [[balanitis]] may present with asymptomatic or symptomatic lesions with [[itch]] or [[pain]] in the genital region. [[Risk factors]], [[pathogenesis]], clinical presentation, [[diagnosis]] and management varies from [[etiology]] to [[etiology]].
 
Lack of aeration and irritation because of [[smegma]] and discharge surrounding the glans penis causes inflammation and edema.
==Classification==


===Zoon's Balanitis===
== Classification  ==
'''Zoon's balanitis''' also known as ''Balanitis Circumscripta Plasmacellularis'' or ''plasma cell balanitis'' (PCB) is an idiopathic, rare, benign penile dermatosis (Keogh, 2005) for which circumcision is often the preferred treatment (Pellice, 1999; Buechner, 2002; Keogh, 2005). Zoon's balanitis has been successfully treated with the carbon dioxide laser (Baldwin, 1989) and more recently Albertini and colleagues report the avoidance of circumcision and successful treatment of Zoon's balanitis with an Er:YAG laser (Albertini, 2002). Another study, by Retamar and colleagues, found that 40 percent of those treated with CO<sub>2</sub> laser relapsed (Retamar, 2003).


===Circinate Balanitis===
There is no established classification system for Balantis. Based on the etiologies, Balanitis can be classified into:<ref name="pmid24828553">{{cite journal| author=Edwards SK, Bunker CB, Ziller F, van der Meijden WI| title=2013 European guideline for the management of balanoposthitis. | journal=Int J STD AIDS | year= 2014 | volume= 25 | issue= 9 | pages= 615-26 | pmid=24828553 | doi=10.1177/0956462414533099 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24828553  }}</ref>
'''Circinate balantitis''' (also known as '''balanitis circinata''') is a serpiginous annular dermatitis associated with[[Reiter's syndrome]].
* [[Infectious balanitis|Infectious]]
==Causes==
* Non-infectious balanitis
Inflammation has many possible causes, including irritation by environmental substances, physical trauma, and infection by a wide variety of pathogens, including bacteria, virus, or fungus &mdash; each of which require a particular treatment (Edwards, 1996).
:*[[Zoon's balanitis]]
===Circumcision===
:*[[Balanitis xerotica obliterans]]
Some studies indicate balanitis to be more common in uncircumcised boys (Fergusson, 1988; Herzog, 1986; Fakjian, 1990; Leber, 2005; Waskett, 2005), but Van Howe found balanitis only in circumcised boys (Van Howe, 1997). Van Howe's study has been criticised for the fact that few boys were uncircumcised (Waskett, 2005).


===Genital Washing===
== Causes ==
Many studies of balanitis do not examine the subjects' genital washing habits. However, O'Farrell ''et al.'' report that failure to wash the whole penis, including retraction of the foreskin in uncircumcised men, is more common among balanitis sufferers (O'Farrell, 2005). Birley ''et al.'', however,  found that ''excessive'' genital washing with soap may be a strong contributing factor to balanitis (Birley, 1993).
==Epidemiology and Demographics==
===Prevalence===
Escala and Rickwood, in a 1989 examination of 100 cases of balanitis in childhood, concluded that the risk "in any individual, uncircumcised boy appears to be no greater than 4%." (Escala, 1989).  Øster reported no balanitis in 9545 observations of uncircumcised Danish boys (Oster, 1968). Balanitis in boys still in nappies must be distinguished from the normal redness seen in boys caused by ammoniacal dermatitis (Simpson, 1998).


While any man can develop balanitis, the condition is most likely to occur in men who have a tight foreskin that is difficult to pull back, or who have poor hygiene. Diabetes can make balanitis more likely, especially if the blood sugar is poorly controlled.
=== '''Infectious balanitis''' ===
'''Common causes of infectious balanitis''' 


==Natural History, Complications and Prognosis==
'''Fungal'''
* [[Candida]] (most common cause)
'''Protozoal'''
* [[Trichomonas vaginalis]]
'''spirochaetes'''
* [[Treponema pallidum]]
'''Viral'''
* [[Herpes simplex]]
* [[Human papillomavirus|Human papilloma virus]]


===Complications===
==== Less common causes of infectious balanitis ====
'''Fungal'''
* [[Dermatophytosis]] 
* [[Pityriasis versicolor]]
* [[Histoplasma capsulatum]]
* [[Blastomyces dermatitidis]]
* [[Cryptococcus neoformans]]


Balanitis may cause oedema (Chow), resulting in [[phimosis]], or inability to retract the foreskin from the glans penis. Adherence of the foreskin to the inflamed and edematous glans penis is the cause (Leber, 2005; Chow; Edwards, 1996).
==== Viral ====
* [[Varicella zoster virus|Varicella zoster virus (VZV)]]


==Diagnosis==
==== Protozoal ====
Diagnosis may include careful identification of the cause with the aid of a good patient history, swabs and cultures, and pathologic examination of a biopsy (Edwards, 1996).
* [[Entamoeba histolytica]]
* [[Leishmania|Leishmania species]]


==External Links==
==== Parasitic ====
*Balanitis - [http://www.intelihealth.com/IH/ihtIH/WSIHW000/9339/10515.html InteliHealth]
* [[Sarcoptes scabiei]]  
*Zoon's Balanitis - [http://www.emedicine.com/derm/topic45.htm InteliHealth]
* [[Pediculosis]]
*Edwards S. (for the Clinical Effectiveness Group) [http://www.bashh.org/guidelines/2002/balanitis_0901b.pdf National guideline on the management of balanitis]. Association for Genitourinary Medicine (UK) and the Medical Society for the Study of Venereal Diseases (UK), 2001.
* [[Ancylostoma]]
===Images of balanitis===
*[http://www.stdservices.on.net/images/std/balanitis/slide10.jpg STD services]
*[http://www.atlasdermatologico.com.br/ListaImagens/Balanitis_Candidomycetica1.JPG Dermatological atlas]


==Related Chapters==
==== Bacterial ====
*[[Penis]]
'''Gram negative bacteria'''
*[[Glans penis]]
* [[Escherichia coli|E.coli]]
*[[Foreskin]]
* [[Pseudomonas]]
*[[Inflammation]]
* [[Haemophilus|Haemophilus parainfluenzae]]
*[[Circumcision]]
* [[Klebsiella]]
*[[Balanitis xerotica obliterans]]
* [[Neisseria gonorrhoeae|Neisseria gonorrhoea]]
* [[Haemophilus ducreyi]]
* [[Mycoplasma genitalium]]
* [[Chlamydia]]
* [[Ureaplasma]]
* [[Gardnerella vaginalis]]
* [[Citrobacter]]
* [[Enterobacter]]


==References==
==== Spirochaetes ====
{{refbegin|2}}
* Non-specific [[spirochaetal]] [[infection]]
# Edwards S. [http://www.circs.org/library/edwards/ Balanitis and balanoposthitis: a review]. ''Genitourin Med'' 1996;72(3):155-9
'''Gram positive organism'''  
# Leber M. [http://www.emedicine.com/emerg/topic51.htm Balanitis]. (online). eMedicine.com. Cited 20 Aug 2005
* [[Streptococci|Haemolytic Streptococci(Group B Streptococci)]]
# Chow KW. [http://www.cirp.org/library/disease/balanitis/chow/ Balanitis and other genital conditions]. In: ''Social Hygiene Handbook''. Hong Kong.
* [[Staphylococci|Staphylococci epidermidis/aureus]]
# Escala JM, Rickwood AMK. [http://www.cirp.org/library/disease/balanitis/escala1/ Balanitis]. ''Brit J Urol'' 1989;63:196-7
'''Acid fast bacilli'''  
# Øster J. [http://www.cirp.org/library/general/oster/ Further fate of the foreskin: incidence of preputial adhesions, phimosis, and smegma among Danish Schoolboys]. ''Arch Dis Child'' 1968;43:200-3
* [[Mycobacterium tuberculosis]]
# Simpson ET, Barraclough P. [http://www.cirp.org/library/hygiene/simpson1/ The management of the paediatric foreskin]. ''Aust Fam Physician'' 1998;27(5):381-3
* [[Mycobacterium leprae]]  
# Fergusson DM, Lawton JM, Shannon FT. [http://www.circs.org/library/fergusson/ Neonatal circumcision and penile problems: an 8-year longitudinal study]. ''Pediatrics'' 1988;81(4):537-41
# Herzog LW, Alvarez SR. [http://www.circs.org/library/herzog/ The frequency of foreskin problems in uncircumcised children]. Am J Dis Child 1986; 140: 254-256
# Fakjian N, Hunter S, Cole GW, Miller J. [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=2383029 An argument for circumcision. Prevention of balanitis in the adult]. ''Arch Dermatol'' 1990 Aug;126(8):1046-7.
# Waskett JH. [http://pediatrics.aappublications.org/cgi/eletters/81/4/537#1382 Balanitis and the uncircumcised male]. Pediatrics. P3R Response (12 Jun 2005)
# Van Howe RS. [http://www.cirp.org/library/complications/vanhowe/ Variability in penile appearance and penile findings: a prospective study]. ''Brit J Urol'' 1997;80:776-782
# Birley HDL, Luzzi GA, Bell R. [http://www.cirp.org/library/disease/balanitis/birley/ Clinical features and management of recurrent balanitis: association with atopy and genital washing]. ''Genitourin Med'' 1993;69(5):400-3
# Pellice i Vilalta C, Casalots i Casado J, Cosme i Jimenez MA. [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10101891&dopt=Abstract Zoon's balanoposthitis. A preliminary note]. ''Arch Esp Urol'' 1999 Jan-Feb;52(1):69-72
# Buechner SA. [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12175386 Common skin disorders of the penis]. ''BJU Int'' 2002 Sep;90(5):498-506.
# Keogh G. [http://www.emedicine.com/derm/topic45.htm Balanitis circumscripta plasmacellularis]. (online). eMedicine.com. Cited 20 Aug 2005
# Baldwin HE, Geronemus RG. [http://www.cirp.org/library/disease/balanitis/baldwin1/ The treatment of Zoon's balanitis with the carbon dioxide laser]. ''J Dermatol Surg Oncol'' 1989 May;15(5):491-4
# Albertini JG, Holck DE, Farley MF. [http://www.cirp.org/library/disease/balanitis/albertini1/ Zoon's balanitis treated with Erbium:YAG laser ablation]. ''Lasers Surg Med'' 2002; 30(2):123-6
# Retamar RA, Kien MC, Chouela EN. [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12694501 Zoon's balanitis: presentation of 15 patients, five treated with a carbon dioxide laser]. ''Int J Dermatol'' 2003 Apr;42(4):305-7
# O'Farrell N, Quigley M, Fox P. [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16105191&query_hl=21 Association between the intact foreskin and inferior standards of male genital hygiene behaviour: a cross-sectional study]. ''Int J STD AIDS'' 2005 Aug;16(8):556-9.
{{refend}}


{{Diseases of the pelvis, genitals and breasts}}
==== Anaerobes ====
* [[Bacteroides]]


[[de:Eichelentzündung]]
=== '''Non-infectious balanitis''' ===
[[es:Balanitis]]
[[fr:Balanite]]
[[it:Balanite]]
[[ms:Balanitis]]
[[nl:Balanitis]]
[[fi:Terskatulehdus]]
[[sv:Balanit]]


==== Inflammatory dermatoses conditions causing balanitis ====
* [[Lichen sclerosus]]
* [[Lichen planus]]
* [[Zoon's balanitis]]
* [[Psoriasis]]
* [[Reiter's Disease|Circinate balanitis]]
* [[Eczema]]
* [[Seborrhoeic dermatitis]]
* [[Fixed drug eruption]]
* Non-specific [[balanoposthitis]]
'''Penile carcinoma in situ causing balanitis'''
* [[Bowenoid papulosis]]
* [[Erythroplasia of Queyrat]]
* [[Bowen's disease]]


[[Category:Circumcision debate]]
= Differential Diagnosis =
[[Category:Inflammations]]
{| class="wikitable"
[[Category:Urology]]
! colspan="3" |Symptoms
[[Category:Penis]]
! colspan="4" |Signs
[[Category:Signs and symptoms]]
|-
[[Category:Primary care]]
!
!Malaise
!Pruritus
!Skin lesions
!Regional lymphadenopathy
!Erythema
!Swelling
|-
|[[Candidiasis|Candida balanitis]]
| -
| +
|[[Erythematous]] [[Rash (patient information)|rash]] with soreness and/or [[itch]]
| +
| +
| -
|-
|[[Trichomonas vaginalis]]
| -
| +
|Superficial erosive [[balanitis]] 
| -
| +
| -
|-
|[[Treponema pallidum]]
| -
| -
|Multiple circinate lesions
| +
| -
| -
|-
|[[Herpes simplex]]
| +
| +
|Grouped [[vesicles]] on [[erythematous]] base
| +
| +
| -
|-
|[[Human papillomavirus|Human papilloma virus]]
| -
| +
|[[Warts]]
| -
| -
| -
|-
|[[Lichen sclerosus]]
| -
| +
|White patches on [[glans]]
| -
| -
| -
|-
|[[Lichen planus]]
| -
| +
|Purplish [[lesions]] on the [[penis]]
| -
| -
| -
|-
|[[Psoriasis]]
| -
| +
|Red scaly [[plaques]]
| -
| +
| -
|-
|[[Reiter's Syndrome|Circinate]]
| +
| +
|Greyish white areas on the [[glans]]
| -
| -
| -
|-
|[[Zoon's balanitis]]
| -
| +
|Well-circumscribed orange-red glazed areas
| -
| -
| -
|-
|[[Eczema]]
| -
| +
|Mild non-specific [[erythema]] to wide spread [[edema]] of [[penis]].
| -
| +
| +
|-
|[[Fixed drug eruption]]
| -
| +
|Well demarcated and [[Erythema|erythematous]] lesions
| -
| +
| -
|-
|[[Bowen's disease]]
| -
| +
|Multiple, small, well-demarcated [[Papillomatosis|papillomatous]] [[papules]]
| -
| -
| -
|-
|[[Bowenoid papulosis]]
| -
| +
|Single or multiple, sharply demarcated associated with [[Scaling skin|scaling]] and crusting
| -
| -
| -
|-
|[[Erythroplasia of Queyrat]]
| -
| +
|Velvety patches and [[plaques]] of [[keratinization]] on [[penis]].
| +
| -
| -
|}


== References ==
{{Reflist|2}}
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Latest revision as of 20:35, 29 July 2020

Balanitis Microchapters

Patient Information

Overview

Classification

Infectious balanitis
Non-infectious balanitits
Zoon's balanitis
Balanitis xerotica obliterans

Causes

Differential Diagnosis

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: Balanoposthitis


Overview

Balanitis is inflammation of glans penis. When inflammation involves the foreskin and prepuce, it is termed as balanoposthitis. Based on the etiology, balanitis can be mainly categorized into infectious, inflammatory dermatoses, and penile carcinoma in situ. Patients with balanitis may present with asymptomatic or symptomatic lesions with itch or pain in the genital region. Risk factors, pathogenesis, clinical presentation, diagnosis and management varies from etiology to etiology.

Classification

There is no established classification system for Balantis. Based on the etiologies, Balanitis can be classified into:[1]

Causes

Infectious balanitis

Common causes of infectious balanitis

Fungal

Protozoal

spirochaetes

Viral

Less common causes of infectious balanitis

Fungal

Viral

Protozoal

Parasitic

Bacterial

Gram negative bacteria

Spirochaetes

Gram positive organism

Acid fast bacilli

Anaerobes

Non-infectious balanitis

Inflammatory dermatoses conditions causing balanitis

Penile carcinoma in situ causing balanitis

Differential Diagnosis

Symptoms Signs
Malaise Pruritus Skin lesions Regional lymphadenopathy Erythema Swelling
Candida balanitis - + Erythematous rash with soreness and/or itch + + -
Trichomonas vaginalis - + Superficial erosive balanitis  - + -
Treponema pallidum - - Multiple circinate lesions + - -
Herpes simplex + + Grouped vesicles on erythematous base + + -
Human papilloma virus - + Warts - - -
Lichen sclerosus - + White patches on glans - - -
Lichen planus - + Purplish lesions on the penis - - -
Psoriasis - + Red scaly plaques - + -
Circinate + + Greyish white areas on the glans - - -
Zoon's balanitis - + Well-circumscribed orange-red glazed areas - - -
Eczema - + Mild non-specific erythema to wide spread edema of penis. - + +
Fixed drug eruption - + Well demarcated and erythematous lesions - + -
Bowen's disease - + Multiple, small, well-demarcated papillomatous papules - - -
Bowenoid papulosis - + Single or multiple, sharply demarcated associated with scaling and crusting - - -
Erythroplasia of Queyrat - + Velvety patches and plaques of keratinization on penis. + - -

References

  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.

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