Balanitis

Balanitis
Other names: Balanoposthitis
Inflammation of the glans penis and the preputial mucosa of a circumcised penis (balanitis)
SpecialtyUrology
SymptomsRedness, pain, discharge, itchiness, white patches[1]
ComplicationsPhimosis[1]
CausesInfectious: Yeast, bacteria, viruses, trichomonas[1]
Inflammation: Eczema, allergic reactions, lichen planus, psoriasis[1]
Pre-cancerous: Bowen's disease, erythroplasia of Queyrat[1]
Risk factorsUncircumcised, poor hygiene, diabetes, over cleaning[1][2]
Diagnostic methodMicrobial culture, tissue biopsy[1]
TreatmentForeskin retraction, washing the area[1]
MedicationAntifungal cream, antibiotics, steroid creams[1]
PrognosisUsually good[3]
Frequency3 to 11% (males at some point)[4]

Balanitis is inflammation of the head of the penis (glans).[1] It typically occurs together with inflammation of the foreskin (posthitis), which is called balanoposthitis.[1] Symptoms may include redness, pain, discharge, itchiness, or white patches.[1] Complication may include phimosis.[1]

Groups of causes include infectious (yeast, bacteria, viruses, trichomonas), inflammatory conditions (eczema, allergic reactions, lichen planus, psoriasis), and pre-cancerous conditions (Bowen's disease, erythroplasia of Queyrat).[1] Risk factors include being uncircumcised, poor hygiene, diabetes, or over cleaning.[1][2] Diagnosis may be based on microbial culture or other testing and occasionally tissue biopsy.[1]

General management involves keeping the foreskin retracted and washing the area.[1] Dilute vinegar (acetic acid 1%) may help.[2] Based on the specific cause antifungal cream (such as clotrimazole), antibiotics, steroid creams, or surgery.[1] Outcomes are usually good.[3] Between 3 and 11% of males are affected at some point in time.[4]

Signs and symptoms

  • Small red erosions on the glans (first sign)
  • Redness of the foreskin
  • Redness of the penis
  • Other rashes on the head of the penis
  • Foul smelling discharge
  • Painful foreskin and penis
  • Balanitis
    Balanitis
  • Balanitis
    Balanitis
  • Balanitis caused by smegma
    Balanitis caused by smegma

Complications

Recurrent bouts of balanitis may cause scarring of the preputial orifice; the reduced elasticity may lead to pathologic phimosis.[5] Further complications may include:

Cause

Inflammation has many possible causes, including irritation by environmental substances, physical trauma, and infection such as bacterial, viral, or fungal.[6][7] Some of these infections are sexually transmitted diseases.

It is less common among people who are circumcised, as in many cases, a dysfunction of the foreskin is a causal or contributing factor.[1] Both not enough cleaning and too much cleaning can cause problems.[1] Diabetes can make balanitis more likely, especially if the blood sugar is poorly controlled.[8]

It is important to exclude other causes of similar symptoms such as penile cancer.[1]

Diagnosis

Diagnosis may include careful identification of the cause with the aid of a good patient history, swabs and cultures, and pathological examination of a biopsy.[6]

Types

  • Zoon's balanitis also known as Balanitis Circumscripta Plasmacellularis or plasma cell balanitis (PCB) is an idiopathic, rare, benign penile dermatosis[9] for which circumcision is often the preferred treatment.[9][10][11] Zoon's balanitis has been successfully treated with the carbon dioxide laser[12] and more recently Albertini and colleagues report the avoidance of circumcision and successful treatment of Zoon's balanitis with an Er:YAG laser.[13] Another study, by Retamar and colleagues, found that 40 percent of those treated with CO2 laser relapsed.[14]
  • Circinate balanitis (also known as balanitis circinata) is a serpiginous annular dermatitis associated with reactive arthritis.
  • Pseudoepitheliomatous keratotic and micaceous balanitis

Treatment

Initial treatment in adults often involves simply pulling back the foreskin and cleaning the penis.[1]

Epidemiology

Balanitis "is a common condition affecting 11% of adult men seen in urology clinics and 3% of children" in the United States; globally, balanitis "may occur in up to 3% of uncircumcised males".[15]

Other animals

Prepuce of a dog affected by balanoposthitis

In dogs, balanoposthitis is caused by a disruption in the integumentary system, such as a wound or intrusion of a foreign body. A dog with this condition behaves normally, with the exception of excessive licking at the prepuce, and a yellow green, pus-like discharge is usually present.

In sheep (rams/wethers), ulcerative enzootic balanoposthitis is caused by the Corynebacterium renale group (C. renale, C. pilosum & C. cystidis).

For the condition in bulls, caused by a virus see Bovine herpesvirus 1.

Balanoposthitis is believed to have contributed to the decline to near-extinction of Gilbert's potoroo.[16]

Word orgin

The word balanitis is from the Greek βάλανος balanos, literally meaning 'acorn', used because of the similarity in shape to the glans penis.[17]

References

  1. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 Edwards, SK; Bunker, CB; Ziller, F; van der Meijden, WI (August 2014). "2013 European guideline for the management of balanoposthitis". International Journal of STD & AIDS. 25 (9): 615–26. doi:10.1177/0956462414533099. PMID 24828553. S2CID 127341.
  2. 1 2 3 "Balanitis | DermNet NZ". dermnetnz.org. Archived from the original on 26 March 2022. Retrieved 27 March 2022.
  3. 1 2 "Balanitis". Archived from the original on 24 March 2022. Retrieved 27 March 2022.
  4. 1 2 Wray, AA; Velasquez, J; Khetarpal, S (January 2022). "Balanitis". PMID 30725828. {{cite journal}}: Cite journal requires |journal= (help)
  5. ↑ Phimosis at eMedicine
  6. 1 2 Edwards S (1996). "Balanitis and balanoposthitis: a review". Genitourin Med. 72 (3): 155–9. doi:10.1136/sti.72.3.155. PMC 1195642. PMID 8707315.
  7. ↑ "Cleveland Clinic: Penile Disorders". Archived from the original on 2012-04-12. Retrieved 2012-04-10.
  8. ↑ Balanitis Archived 2016-04-19 at the Wayback Machine. Health Line. Retrieved 19 April 2016.
  9. 1 2 Keogh G. Balanitis circumscripta plasmacellularis at eMedicine
  10. ↑ Pellicé i Vilalta C, Casalots i Casado J, Cosme i Jiménez MA (1999). "[Zoon's balanoposthitis. A preliminary note]". Arch. Esp. Urol. (in español). 52 (1): 69–72. PMID 10101891.
  11. ↑ Buechner SA (2002). "Common skin disorders of the penis". BJU Int. 90 (5): 498–506. doi:10.1046/j.1464-410X.2002.02962.x. PMID 12175386. S2CID 45605100.
  12. ↑ Baldwin HE, Geronemus RG (1989). "The treatment of Zoon's balanitis with the carbon dioxide laser". J Dermatol Surg Oncol. 15 (5): 491–4. doi:10.1111/j.1524-4725.1989.tb03407.x. PMID 2497162.
  13. ↑ Albertini JG, Holck DE, Farley MF (2002). "Zoon's balanitis treated with Erbium:YAG laser ablation". Lasers Surg Med. 30 (2): 123–6. doi:10.1002/lsm.10037. PMID 11870791. S2CID 33098632. Archived (PDF) from the original on 2021-08-27. Retrieved 2019-07-01.
  14. ↑ Retamar RA, Kien MC, Chouela EN (2003). "Zoon's balanitis: presentation of 15 patients, five treated with a carbon dioxide laser". Int. J. Dermatol. 42 (4): 305–7. doi:10.1046/j.1365-4362.2003.01304.x. PMID 12694501. S2CID 21305117.
  15. ↑ Balanitis at eMedicine
  16. ↑ Vaughan-Higgins, Rebecca; Buller, Nicky; Friend, J. Anthony; Robertson, Ian; Monaghan, Cree L.; Fenwick, Stan; Warren, Kristin (2011). "Balanoposthitis, Dyspareunia, and Treponema in the Critically Endangered Gilbert's Potoroo (Potorous gilbertii)". Journal of Wildlife Diseases. 47 (4): 1019–1025. doi:10.7589/0090-3558-47.4.1019. PMID 22102677. S2CID 7279808. Archived from the original on 2019-11-15. Retrieved 2019-07-01.
  17. ↑ βάλανος. Liddell, Henry George; Scott, Robert; A Greek–English Lexicon at the Perseus Project.
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