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{{Balanitis}}
{{BalanitisV}}
{{CMG}}; {{AE}}{{VD}}
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==Overview==
==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 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 depending on etiology.
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]]. 
==[[Balanitis historical perspective|Historical Perspective]]==
Balanitis is an ancient disease,The term Balanitis is derived from a Greek term balanos or acorn.
==Classification==
There is no established classification system for Balantis. Based on the etiologies, Balanitis can be classified into:<ref name="pmid248285532">{{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>
*[[Infectious balanitis|Infectious]]
*[[Inflammatory dermatoses]]
*[[Penile carcinoma in situ]]
==[[Balanitis pathophysiology|Pathophysiology]]==


==Causes ==
== Classification  ==
==Differential diagnosis ==
==[[Balanitis epidemiology and demographics|Epidemiology and Demographics]]==
==[[Balanitis risk factors|Risk Factors]]==


==[[Balanitis screening|Screening]]==
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>
There is no established clinical guidelines for screening patients for balanitis.
* [[Infectious balanitis|Infectious]]  
==[[Balanitis natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
* [[Inflammatory dermatoses]]  
==Diagnosis==
* [[Penile carcinoma in situ]]  
[[Balanitis diagnostic criteria| Diagnostic Criteria]] | [[Balanitis history and symptoms| History and Symptoms]] | [[Balanitis physical examination| Physical Examination]] | [[Balanitis laboratory findings| Laboratory Findings]] | [[Balanitis chest x ray|X-ray]]|[[CT-Scan]]| [[MRI]]| [[Balanitis other diagnostic studies|Other Diagnostic Studies]]
==Treatment==
[[Balanitis medical therapy|Medical Therapy]] | [[Balanitis primary prevention|Primary Prevention]] | [[Balanitis secondary prevention|Secondary Prevention]] | [[Balanitis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Balanitis future or investigational therapies|Future or Investigational Therapies]]


==References==
{{familytree/start}}
{{familytree | | | | | | | | | | | | | | | | | A01 |A01='''Balanitis'''}}
{{familytree | | | | |,|-|-|-|-|-|-|-|-|-|-|-|-|+|-|-|-|-|-|-|-|-|-|-|.| | | }}
{{familytree | | | | B01 | | | | | | | | | | | B02 | | | | | | | | | B03 |B01='''Infectious'''|B02='''Inflammatory dermatoses'''|B03='''Premalignant(penile carcinoma in situ)'''}}
{{familytree | | | | |!| | | | | | | | | | | | |!| | | | | | | | | | |!| | | }}
{{familytree | | | | |!| | | | | | | | | | | | |!| | | | | | | | | | |!| | | }}
{{familytree | | | | C01 | | | | | | | | | | | C02 | | | | | | | | | C03 |C01=[[Candida]] (albicans, krusei)<br>[[Streptococci]]<br>Anaerobes<br>[[Staphylococci]]<br>[[Trichomonas vaginalis]]<br>[[Herpes simplex virus]]<br>[[Human papillomavirus]]<br>[[Mycoplasma genitalium]]|C02=[[Lichen sclerosus]]<br>[[Lichen planus]]<br>[[Psoriasis]]<br>[[Circinate balanitis]]<br>[[Zoon's balanitis]]<br>[[Eczema]]<br>[[Allergic reactions]]|C03= [[Bowen's disease]]<br>[[Bowenoid papulosis]]<br>[[Erythroplasia of Queyrat]]}}
{{familytree/end}}
 
==Diagnosis and management==
<br>'''''Adopted from National Guideline on the Management of Balanoposthitis UK 2008'''''<br>
{| align=center
|-
|
{{familytree/start |summary=Diagnostic and Management approach of balanitis and balanoposthitis}}
{{familytree | | | | | | | | | | | A01 | | A01=Balanitis/balanoposthitis}} 
{{familytree | | | | | | | | | | | |!| | |}}
{{familytree | | | | | | | | | | | B01 | | B01=Take history and examine}}
{{familytree | | | |,|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|.| | | }}
{{familytree | | | C01 | | | | | | | | | | | | | | C02 | |C01=Perpuce retracts|C02=Perpuce does not retract}}
{{familytree | |,|-|^|-|-|-|-|.| | | | | | |,|-|-|-|^|-|-|.| |}}
{{familytree | D01 | | | | | D02 | | | | | | D03 | | | | D04 |D01=Ulceration present|D02=Erythema,subpreputial discharge|D03=Prepuce scarred|D04=Prepuce swollen}}
{{familytree | |!| | | |,|-|-|^|-|.| | | | | |!| | | | | |!|}}
{{familytree | E01 | | E02 | | | E03 | | | | E04 | | | | E05 |E01=Follow genital ulcer protocol|E02=Fowl smelling|E03=No odour|E04=Refer to surgical opinion|E05=Treat as genital ulcer disease}}
{{familytree | |!| | | |!| | | | |!| | | | | |!| | | | | |!| | | |}}
{{familytree | |!| | | F01 | | | F02 | | | | |!| | | | | |!| | | | |F01=Metronidazole 400 mg bd|F02=Antifungal+1% Hydrocortisone cream apply bd}}
{{familytree | |!| | | |!| | | | |!| | | | | |!| | | | | |!|}}
{{familytree | |`|-|-|-|^|-|-| G01 |-|-|-|-|-|^|-|-|-|-|-|'| | | | | | |G01=Review}}
{{familytree | | | | | | | |,|-|^|-|.| | | | | | | | | | | | | | |}}
{{familytree | | | | | | | H01 | | H02 | | | | | | | | | | | | | | | |H01=If better discharge|H02=If not better 1) Reassess-try alternative pathway 2) Erythromycin 500 bd 3) Potent steroid cream}}
{{familytree/end}}
|}
 
==Synopsis==
{| class="wikitable"
! colspan="3" |Symptoms
! colspan="4" |Signs
|-
!
!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}}
{{Reflist|2}}
[[Category:Balanitis]]
[[Category:Balanitis]]

Revision as of 14:40, 2 March 2017

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

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]

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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. ✔ ✖ ✖

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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