Balanitis

Template:BalanitisV 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

• Please click here to know more about Zoon's Balanitis
• Please click here to know more about Balanitis xerotica obliterans

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 depending on etiology.

Classification

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

• Infectious
• Inflammatory dermatoses
• Penile carcinoma in situ

Balanitis

Infectious

Inflammatory dermatoses

Premalignant (penile carcinoma in situ)

Candida (albicans, krusei) Streptococci Anaerobes Staphylococci Trichomonas vaginalis Herpes simplex virus Human papillomavirus Mycoplasma genitalium

Lichen sclerosus Lichen planus Psoriasis Circinate balanitis Zoon's balanitis Eczema Allergic reactions

Bowen's disease Bowenoid papulosis Erythroplasia of Queyrat

Diagnosis and management

Adopted from National Guideline on the Management of Balanoposthitis UK 2008

Balanitis/balanoposthitis                                                     Take history and examine                                                                                               Perpuce retracts                           Perpuce does not retract                                                                                                   Ulceration present         Erythema,subpreputial discharge           Prepuce scarred       Prepuce swollen                                                                         Follow genital ulcer protocol   Fowl smelling     No odour       Refer to surgical opinion       Treat as genital ulcer disease                                                                         Metronidazole 400 mg bd     Antifungal+1% Hydrocortisone cream apply bd                                                                                                               Review                                                                                                                                                                 If better discharge   If not better 1) Reassess-try alternative pathway 2) Erythromycin 500 bd 3) Potent steroid cream

Synopsis

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.	✔	✖	✖