Sandbox:Inflammatory dermatosis: Difference between revisions

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{{SK}}
==Overview==
Inflammatory dermatosis of penis represents a group of inflammatory conditions which effect the penis causing Balanitis. Pathogenesis, risk factors, clinical features, laboratory findings and treatment vary from condition to condition.
* '''Please click here to know more about Zoon's Balanitis'''
* '''Please click here to know more about Balanitis xerotica obliterans'''
* '''Please click here to know more about Lichen sclerosus'''
* '''Please click here to know more about Lichen planus'''
* '''Please click here to know more about Psoriasis'''
* '''Please click here to know more about Circinate balanitits'''
* '''Please click here to know more about [[Eczema]]'''
* '''Please click here to know more about [[Seborrhoeic dermatitis]]'''
* '''Please click here to know more about [[Fixed drug eruption]]'''


'''Please click here to know more about Zoon's Balanitis'''
==Distinguishing clincal features, diagnosis, management of balanitis due to inflammatory dermatosis==
 
Distinguishing clincal features, diagnosis, management of balanitis due to inflammatory dermatosis, include:<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><ref name="pmid16909057">{{cite journal| author=Kishimoto M, Lee MJ, Mor A, Abeles AM, Solomon G, Pillinger MH| title=Syphilis mimicking Reiter's syndrome in an HIV-positive patient. | journal=Am J Med Sci | year= 2006 | volume= 332 | issue= 2 | pages= 90-2 | pmid=16909057 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16909057  }} </ref><ref name="pmid20854400">{{cite journal| author=Neill SM, Lewis FM, Tatnall FM, Cox NH, British Association of Dermatologists| title=British Association of Dermatologists' guidelines for the management of lichen sclerosus 2010. | journal=Br J Dermatol | year= 2010 | volume= 163 | issue= 4 | pages= 672-82 | pmid=20854400 | doi=10.1111/j.1365-2133.2010.09997.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20854400  }} </ref><ref name="pmid22161424">{{cite journal| author=Chi CC, Kirtschig G, Baldo M, Brackenbury F, Lewis F, Wojnarowska F| title=Topical interventions for genital lichen sclerosus. | journal=Cochrane Database Syst Rev | year= 2011 | volume=  | issue= 12 | pages= CD008240 | pmid=22161424 | doi=10.1002/14651858.CD008240.pub2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22161424  }} </ref><ref name="pmid12452865">{{cite journal| author=Porter WM, Francis N, Hawkins D, Dinneen M, Bunker CB| title=Penile intraepithelial neoplasia: clinical spectrum and treatment of 35 cases. | journal=Br J Dermatol | year= 2002 | volume= 147 | issue= 6 | pages= 1159-65 | pmid=12452865 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12452865  }} </ref><ref name="pmid12454596">{{cite journal| author=Weyers W, Ende Y, Schalla W, Diaz-Cascajo C| title=Balanitis of Zoon: a clinicopathologic study of 45 cases. | journal=Am J Dermatopathol | year= 2002 | volume= 24 | issue= 6 | pages= 459-67 | pmid=12454596 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12454596  }} </ref><ref name="pmid7750950">{{cite journal| author=Kumar B, Sharma R, Rajagopalan M, Radotra BD| title=Plasma cell balanitis: clinical and histopathological features--response to circumcision. | journal=Genitourin Med | year= 1995 | volume= 71 | issue= 1 | pages= 32-4 | pmid=7750950 | doi= | pmc=1195366 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7750950  }} </ref><ref name="pmid17497162">{{cite journal| author=Nast A, Kopp I, Augustin M, Banditt KB, Boehncke WH, Follmann M et al.| title=German evidence-based guidelines for the treatment of Psoriasis vulgaris (short version). | journal=Arch Dermatol Res | year= 2007 | volume= 299 | issue= 3 | pages= 111-38 | pmid=17497162 | doi=10.1007/s00403-007-0744-y | pmc=1910890 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17497162  }} </ref><ref name="pmid15307969">{{cite journal| author=Zawar V, Kirloskar M, Chuh A| title=Fixed drug eruption - a sexually inducible reaction? | journal=Int J STD AIDS | year= 2004 | volume= 15 | issue= 8 | pages= 560-3 | pmid=15307969 | doi=10.1258/0956462041558285 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15307969  }} </ref>
'''Please click here to know more about Balanitis xerotica obliterans'''
==Overview==
==Causes==
{| class="wikitable"
{| class="wikitable"
! colspan="7" |2013 European guideline for the management of balanoposthitis
! colspan="6" |Distinguishing clincal features, diagnosis, and management of balanitis due to inflammatory dermatosis
|-
|-
!
!
!Clinical features
!Distinguishing clinical features shown on the penis
!Diagnosis
!Diagnosis
! colspan="4" |Management
! colspan="3" |Management
|-
|-
!
!
Line 24: Line 31:
!Alternative regimens
!Alternative regimens
!Follow-up
!Follow-up
!Other recommendations
|-
|-
|Lichen sclerosus
|[[Lichen sclerosus]]
|White patches on the glans, often with involvement of the prepuce. There may be haemorrhagic vesicles, purpura and rarely blisters and ulceration. Architectural changes include blunting of the coronal sulcus, phimosis or wasting of the prepuce, and meatal thickening and narrowing.
|
|Diagnosis is with Biopsy
* White patches on glans, which may often involve prepuce.
* Haemorrhagic vesicles, purpura with rarely blisters and ulceration may be present .
|'''Biopsy'''
*Epidermis: Thickened epidermis which then becomes atrophic with follicular hyperkeratosis.
*Epidermis: Thickened epidermis which then becomes atrophic with follicular hyperkeratosis.
*Dermis: Dermal hyalinisation with loss of elastin fibers and underlying perivascular lymphocytic infiltrate
*Dermis: Dermal hyalinisation with loss of elastin fibers and underlying perivascular lymphocytic infiltrate
|
|
* Ultrapotent topical steroids(e.g. clobetasol proprionate) applied once daily until remission, then gradually reduced. Intermittent use (e.g. once weekly) may be required to maintain remission. A double-blind study in children showed response to topical mometasone furoate, particularly in early cases without scarring.
*Ultrapotent topical steroids(e.g. clobetasol proprionate) applied once daily until remission, then gradually reduced. Intermittent use (e.g. once weekly) may be required to maintain remission.
* In view of the immunosuppressive effects of potent steroids, patients with a history of genital warts should be warned about the risk of a relapse; consider prophylactic acyclovir in patients with a history of genital HSV infection.
*Secondary infection should be treated.
* Secondary infection should be treated.
|
|
* Although topical calcineurin inhibitors have been claimed to be efficacious (pimecrolimus applied twice daily, there is concern about the risk of malignancy.
*Although topical calcineurin inhibitors have been claimed to be efficacious (pimecrolimus applied twice daily, there is concern about the risk of malignancy.
* Surgery may be indicated to address symptoms due to persistent phimosis or meatal stenosis.This may include circumcision, meatotomy or urethroplasty.
*Surgery is indicated when lesion are associated with phimosis and meatal stenosis. Surgical procedures include circumcision, meatotomy ot urethroplasty.
* Circumcision is indicated for failed topical medical treatment.
*Circumcision is indicated for failed topical medical treatment.
|
* Patients with a persistent requirement for topical treatment should be circumcised.
* Patients with atypical or persistent lesions should receive more specialist input.
* Patients should be advised to contact the general practitioner or clinic if the appearances change.
|
|
*Persistent requirement for topical treatment is an indication of circumcision.
*Patients should be advised to contact the health care provider if they notice any change in appearances of the lesion.
|-
|-
|[[Lichen planus]]
|[[Lichen planus]]
|Purplish lesions, or supporting evidence of lichen planus lesions elsewhere on the body. This particularly includes the mouth in cases of erosive (penogingival) disease
|
|Biospsy
* Purlish lesions on the
* Presence of lichen planus lesions elsewhere in body
|'''Biopsy'''
Irregular saw-toothed acanthosis, increased granular layer and basal cell liquefaction.
Irregular saw-toothed acanthosis, increased granular layer and basal cell liquefaction.


Dermis: Band-like dermal infiltrate (mainly lymphocytic).
Dermis: Band-like dermal infiltrate (mainly lymphocytic).
|Moderate to ultrapotent topical steroids depending on severity (for both mucosal and cutaneous disease)
|Moderate to ultrapotent topical steroids depending on severity
|
* Topical and oral ciclosporin have been used for erosive disease.
* Topical calcineurin inhibitors have also been tried in lichen planus of the vulval and oral mucosa (pimecrolimus applied twice daily, but no specific reports in penile disease (noting the caution as for lichen sclerosus).
* Circumcision: May be the treatment of choice for some cases of erosive lichen planus
|
|
* Patients with a persistent requirement for topical treatment should be circumcised.
*Topical and oral ciclosporin have been used for erosive disease.
* Atypical or persistent disease should receive more specialist input.
*Circumcision: May be the treatment of choice for some cases of erosive lichen planus
* Patients should be advised to contact the general practitioner or clinic if the appearances change
|
|
*Persistent requirement for topical treatment is an indication of circumcision.
*Patients should be advised to contact the health care provider if they notice any change in appearances of the lesion.
|-
|-
|Zoon’s (plasma cell) balanitis
|[[Zoon’s balanitis|Zoon’s (plasma cell) balanitis]]
|well-circumscribed orange-red glazed areas on the glans and the inside of the foreskin, with multiple pinpoint redder spots – ‘cayenne pepper spots.’ These are in a symmetrical distribution
|
|
* Well-circumscribed orange-red glazed areas on the glans and foreskin.
* Multiple symmetrical pinpoint redder spots – ‘cayenne pepper spots.’
|'''Biopsy'''
*Epidermis: Epidermis thickening which is followed by epidermal atrophy, at times with erosions.
*Epidermis: Epidermis thickening which is followed by epidermal atrophy, at times with erosions.
*Dermis: Plasma cell infiltrate with haemosiderin and extravasated red blood cells.
*Dermis: Plasma cell infiltrate with haemosiderin and extravasated red blood cells.
|
|
* Circumcision – this has been reported to lead to the resolution of lesions.
*Circumcision
* Topical steroid preparations – with or without added antibacterial agents e.g. Trimovate cream, applied once or twice daily.
*Topical steroid preparations - Trimovate cream, applied once or twice daily.
* Hygiene measures.
*Hygiene measures.
|
* CO2 laser – this has been used to treat individual lesions
* Although topical tacrolimus has been reported in the treatment of Zoon’s balanitis. there is controversy about the risk of malignancy with the use of topical calcineurin inhibitors
|
|
* Dependent on clinical course and treatment used, especially if topical steroids are being used longterm.
*CO2 laser
* Penile biopsy should be performed if features are atypical or do not resolve with treatment.
*Topical tacrolimus
* It should be remembered that there are cases where even biopsies failed to identify pre-malignant disease.
|
|
*In atypical cases or cases which do not resolve with with treatment penile biopsy should be performed.
|-
|-
|[[Psoriasis]]
|[[Psoriasis]]
|circumcised male psoriasis on the glans is similar to the appearance of the condition elsewhere, with red scaly plaques.
|'''Circumcised male'''
uncircumcised scaling is lost and the patches appear red and glazed.
Red scaly plaques
|Biopsy:
 
'''Uncircumcised'''
* Patches appear red and glazed
* Scaling is lost
|'''Biopsy'''
Parakeratosis and acanthosis with elongation of rete ridges. Collections of neutrophils in the epidermis may be present.
Parakeratosis and acanthosis with elongation of rete ridges. Collections of neutrophils in the epidermis may be present.
|
|
* Moderate potency topical steroids( antibiotic and antifungal).
*Moderate potency topical steroids( antibiotic and antifungal).
* Emollients
*Emollients
|
* Topical Vitamin D preparations (calcipotriol or calcitriol applied twice daily)
* Topical bethamethasone dipropionate/calcipotriol ointment may be well tolerated in treatment of anogenital psoriasis, but potent steroids may not be indicated
* Topical tacrolimus has been used in small studies42 but should not be used as first-line therapy
* Topical pimecrolimus can also be useful.
|
|
*Topical Vitamin D preparations (calcipotriol or calcitriol applied twice daily)
*Topical bethamethasone dipropionate/calcipotriol ointment may be well tolerated in treatment of anogenital psoriasis, but potent steroids may not be indicated
*Topical tacrolimus has been used in small studies but should not be used as first-line therapy
*Topical pimecrolimus can also be useful.
|
|
|-
|-
|[[Reiter's syndrome|Circinate balanitis]]
|[[Reiter's syndrome|Circinate balanitis]]
|Typical appearance: greyish white areas on the glans which coalesce to form ‘geographical’ areas with a white margin. It may be associated with other features of Reiter’s syndrome but can occur without.
|
|.Biopsy:
* Greyish white areas on the glans
* These areas may coalesce to form ‘geographical’ areas with a white margin
* Usually associated with Reiters syndrome
|'''Biopsy'''
Epidermis: Spongiform pustules in the upper epidermis.
Epidermis: Spongiform pustules in the upper epidermis.
|
|
* Screening for STIs. Syphilis can also give rise to similar features.Consider testing for HLAB27.
*Screening for STIs. Syphilis can also give rise to similar features.
* A positive test can confirm a diagnosis and provide important information about the risk of associated disease, such as urethritis, gastrointestinal disease and arthritis
*Consider testing for HLAB27.
|Sexual partners . If an STI is diagnosed, the partner(s) should be treated as per the appropriate protocol.
*A positive test can confirm a diagnosis and provide important information about the risk of associated disease, such as urethritis, gastrointestinal disease and arthritis
|. May be needed for persistent symptomatic lesions. . Associated STIs should be followed up as per appropriate guidelines.
*STD's: Sexual partners should be tested for STD's.
|
|
|Follow up may be needed in persistent symptomatic lesions.
|-
|-
|[[Eczema]]
|[[Eczema]]
|Symptoms ranges from mild non-specific erythema to widespread oedema of the penis.
|Eczema may present has mild non-specific erythema to wide spread edema on penis .
|Biopsy: eczematous with spongiosis and non-specific inflammation.
|'''Biopsy'''
Eczematous with spongiosis and non-specific inflammation.
|
|
* Hydrocortisone 1% applied once or twice daily until resolution of symptoms
* Patients should be advice to avoid precipitants(Soap) and apply emollients.
 
*Hydrocortisone 1% applied once or twice daily until resolution of symptoms
|
|
* In more florid cases more potent topical steroids may be required and may need to be combined with antifungals and/or antibiotics.
*Potent topical steroids combine with antifungal and antibiotics may be needed in florid cases


* Hydrocortisone 1% applied once or twice daily until resolution of symptoms
*Hydrocortisone 1% can be applied until resolution of symptoms
|
|
* Not required, although recurrent problems are common and the patients need to be informed of this.
*Follow up is usually not required.
|
*Avoidance of precipitants – especially soaps.5 . Emollients – applied as required and used as a soap substitute.
|-
|-
|[[Seborrhoeic dermatitis]]
|[[Seborrhoeic dermatitis]]
|Mild itch or redness (less likely to have scaling at this site)
|Mild itch or redness
|
|
|Antifungal cream with a mild to moderate steroid.
|Antifungal cream with a mild to moderate steroid.
|
|
* Oral azole  itraconazole
*Oral azole  itraconazole
* Oral tetracycline
*Oral tetracycline
* Oral terbinafine may be effective43
*Oral terbinafine may be effective43
|
|
|
|-
|-
|[[Fixed drug eruption]]
|[[Fixed drug eruption]]
|Well demarcated and erythematous, but can be bullous with subsequent ulceration
|
|Biopsy:
* Well demarcated and erythematous lesions.
* Lesion may be bullous and may undergo subsequent ulceration
|'''Biopsy'''
*Hydropic degeneration of the basal layer
*Hydropic degeneration of the basal layer
*Epidermal detachment and necrosis with pigmentary incontinence.
*Epidermal detachment and necrosis with pigmentary incontinence.
|
|
* Condition will settle without treatment .
*Condition will settle without treatment .
* Topical steroids – e.g. mild to moderate strength twice daily until resolution
*Topical steroids – e.g. mild to moderate strength twice daily until resolution
* Rarely systemic steroids may be required if the lesions are severe.
*Rarely systemic steroids may be required if the lesions are severe.
|
|
|
|
|
|-
|-
|Non-specific balanoposthitis
|Non-specific balanoposthitis
|Chronic symptomatic presentation with relapses and remissions or persistence. No unifying diagnosis and poor response to a range of topical and oral treatments.
|Chronic symptomatic presentation with relapses and remissions or persistence.
|
|
* Failure to respond to maximal topical steroid and antifungal treatments (including potent steroids). Non-specific histology on biopsy. Non-specific histology at circumcision. No evidence of underlying infective cause (e.g. Chlamydia or mycoplasma).
*Failure to respond to maximal topical steroid and antifungal treatments.
*Non-specific histology on biopsy.
|Circumcision is curative.
|Circumcision is curative.
|
|
|
|
|
|}
|}
==References==
==References==
{{Reflist|2}}
[[Category:Balanitis]]
[[Category:Infectious diseases]]
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Latest revision as of 17:54, 8 February 2017


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

Overview

Inflammatory dermatosis of penis represents a group of inflammatory conditions which effect the penis causing Balanitis. Pathogenesis, risk factors, clinical features, laboratory findings and treatment vary from condition to condition.

  • Please click here to know more about Zoon's Balanitis
  • Please click here to know more about Balanitis xerotica obliterans
  • Please click here to know more about Lichen sclerosus
  • Please click here to know more about Lichen planus
  • Please click here to know more about Psoriasis
  • Please click here to know more about Circinate balanitits
  • Please click here to know more about Eczema
  • Please click here to know more about Seborrhoeic dermatitis
  • Please click here to know more about Fixed drug eruption

Distinguishing clincal features, diagnosis, management of balanitis due to inflammatory dermatosis

Distinguishing clincal features, diagnosis, management of balanitis due to inflammatory dermatosis, include:[1][2][3][4][5][6][7][8][9]

Distinguishing clincal features, diagnosis, and management of balanitis due to inflammatory dermatosis
Distinguishing clinical features shown on the penis Diagnosis Management
Recommended regimen Alternative regimens Follow-up
Lichen sclerosus
  • White patches on glans, which may often involve prepuce.
  • Haemorrhagic vesicles, purpura with rarely blisters and ulceration may be present .
 Biopsy
  • Epidermis: Thickened epidermis which then becomes atrophic with follicular hyperkeratosis.
  • Dermis: Dermal hyalinisation with loss of elastin fibers and underlying perivascular lymphocytic infiltrate
  • Ultrapotent topical steroids(e.g. clobetasol proprionate) applied once daily until remission, then gradually reduced. Intermittent use (e.g. once weekly) may be required to maintain remission.
  • Secondary infection should be treated.
  • Although topical calcineurin inhibitors have been claimed to be efficacious (pimecrolimus applied twice daily, there is concern about the risk of malignancy.
  • Surgery is indicated when lesion are associated with phimosis and meatal stenosis. Surgical procedures include circumcision, meatotomy ot urethroplasty.
  • Circumcision is indicated for failed topical medical treatment.
  • Persistent requirement for topical treatment is an indication of circumcision.
  • Patients should be advised to contact the health care provider if they notice any change in appearances of the lesion.
Lichen planus
  • Purlish lesions on the
  • Presence of lichen planus lesions elsewhere in body
 Biopsy

Irregular saw-toothed acanthosis, increased granular layer and basal cell liquefaction.

Dermis: Band-like dermal infiltrate (mainly lymphocytic).

Moderate to ultrapotent topical steroids depending on severity
  • Topical and oral ciclosporin have been used for erosive disease.
  • Circumcision: May be the treatment of choice for some cases of erosive lichen planus
  • Persistent requirement for topical treatment is an indication of circumcision.
  • Patients should be advised to contact the health care provider if they notice any change in appearances of the lesion.
Zoon’s (plasma cell) balanitis
  • Well-circumscribed orange-red glazed areas on the glans and foreskin.
  • Multiple symmetrical pinpoint redder spots – ‘cayenne pepper spots.’
 Biopsy
  • Epidermis: Epidermis thickening which is followed by epidermal atrophy, at times with erosions.
  • Dermis: Plasma cell infiltrate with haemosiderin and extravasated red blood cells.
  • Circumcision
  • Topical steroid preparations - Trimovate cream, applied once or twice daily.
  • Hygiene measures.
  • CO2 laser
  • Topical tacrolimus
  • In atypical cases or cases which do not resolve with with treatment penile biopsy should be performed.
Psoriasis Circumcised male

Red scaly plaques

Uncircumcised

  • Patches appear red and glazed
  • Scaling is lost
 Biopsy

Parakeratosis and acanthosis with elongation of rete ridges. Collections of neutrophils in the epidermis may be present.

  • Moderate potency topical steroids( antibiotic and antifungal).
  • Emollients
  • Topical Vitamin D preparations (calcipotriol or calcitriol applied twice daily)
  • Topical bethamethasone dipropionate/calcipotriol ointment may be well tolerated in treatment of anogenital psoriasis, but potent steroids may not be indicated
  • Topical tacrolimus has been used in small studies but should not be used as first-line therapy
  • Topical pimecrolimus can also be useful.
Circinate balanitis
  • Greyish white areas on the glans
  • These areas may coalesce to form ‘geographical’ areas with a white margin
  • Usually associated with Reiters syndrome
 Biopsy

Epidermis: Spongiform pustules in the upper epidermis.

  • Screening for STIs. Syphilis can also give rise to similar features.
  • Consider testing for HLAB27.
  • A positive test can confirm a diagnosis and provide important information about the risk of associated disease, such as urethritis, gastrointestinal disease and arthritis
  • STD's: Sexual partners should be tested for STD's.
 Follow up may be needed in persistent symptomatic lesions.
Eczema Eczema may present has mild non-specific erythema to wide spread edema on penis . Biopsy

Eczematous with spongiosis and non-specific inflammation.

  • Patients should be advice to avoid precipitants(Soap) and apply emollients.
  • Hydrocortisone 1% applied once or twice daily until resolution of symptoms
  • Potent topical steroids combine with antifungal and antibiotics may be needed in florid cases
  • Hydrocortisone 1% can be applied until resolution of symptoms
  • Follow up is usually not required.
Seborrhoeic dermatitis Mild itch or redness Antifungal cream with a mild to moderate steroid.
  • Oral azole itraconazole
  • Oral tetracycline
  • Oral terbinafine may be effective43
Fixed drug eruption
  • Well demarcated and erythematous lesions.
  • Lesion may be bullous and may undergo subsequent ulceration
 Biopsy
  • Hydropic degeneration of the basal layer
  • Epidermal detachment and necrosis with pigmentary incontinence.
  • Condition will settle without treatment .
  • Topical steroids – e.g. mild to moderate strength twice daily until resolution
  • Rarely systemic steroids may be required if the lesions are severe.
Non-specific balanoposthitis Chronic symptomatic presentation with relapses and remissions or persistence.
  • Failure to respond to maximal topical steroid and antifungal treatments.
  • Non-specific histology on biopsy.
 Circumcision is curative.

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.
  2. ↑ Kishimoto M, Lee MJ, Mor A, Abeles AM, Solomon G, Pillinger MH (2006). "Syphilis mimicking Reiter's syndrome in an HIV-positive patient". Am J Med Sci. 332 (2): 90–2. PMID 16909057.
  3. ↑ Neill SM, Lewis FM, Tatnall FM, Cox NH, British Association of Dermatologists (2010). "British Association of Dermatologists' guidelines for the management of lichen sclerosus 2010". Br J Dermatol. 163 (4): 672–82. doi:10.1111/j.1365-2133.2010.09997.x. PMID 20854400.
  4. ↑ Chi CC, Kirtschig G, Baldo M, Brackenbury F, Lewis F, Wojnarowska F (2011). "Topical interventions for genital lichen sclerosus". Cochrane Database Syst Rev (12): CD008240. doi:10.1002/14651858.CD008240.pub2. PMID 22161424.
  5. ↑ Porter WM, Francis N, Hawkins D, Dinneen M, Bunker CB (2002). "Penile intraepithelial neoplasia: clinical spectrum and treatment of 35 cases". Br J Dermatol. 147 (6): 1159–65. PMID 12452865.
  6. ↑ 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.
  7. ↑ Kumar B, Sharma R, Rajagopalan M, Radotra BD (1995). "Plasma cell balanitis: clinical and histopathological features--response to circumcision". Genitourin Med. 71 (1): 32–4. PMC 1195366. PMID 7750950.
  8. ↑ Nast A, Kopp I, Augustin M, Banditt KB, Boehncke WH, Follmann M; et al. (2007). "German evidence-based guidelines for the treatment of Psoriasis vulgaris (short version)". Arch Dermatol Res. 299 (3): 111–38. doi:10.1007/s00403-007-0744-y. PMC 1910890. PMID 17497162.
  9. ↑ Zawar V, Kirloskar M, Chuh A (2004). "Fixed drug eruption - a sexually inducible reaction?". Int J STD AIDS. 15 (8): 560–3. doi:10.1258/0956462041558285. PMID 15307969.

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