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| {{SK}} balanoposthitis | | {{SK}} balanoposthitis |
| ==Overview== | | ==Overview== |
| ==Historical Perspective==
| | ==Classification == |
| ==Classification== | |
| ==Pathophysiology==
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| Balanitis being a clinical diagnosis, the pathogenesis varies based on etiology:
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| ===Infectious===
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| Commonly in the presence of risk factors( poor personal hygiene, antibiotic use, corticosteroid use, Immunocompromised, and Diabetes). Infectious organisms like candida, anaerobic, and aerobic bacteria colonize the region of glans penis, which results in inflammation of the glans penis(Balanitis). When the inflammation involves foreskin and prepuce, it is known as balanoposthitis .
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| ===Non-infectious===
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| ====Balanitis xerotica obliterans or Penile lichen sclerosus====
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| etiology and pathogenesis of Balanitis xerotica obliterans is not clearly known. Following theories have been postulated:
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| *Accumlation of epithelial debris and secretions between foreskin and penis proximal to coronal sulcus, results in chronic physical irritation or subclinical trauma, which in turn results in skin lesion along the lines the trauma.
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| *Accumulated material may also harbor infections agents.
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| *Association with autoimmune diseases is identifies in few cases. Human leukocyte antigen (HLA) HLA DQ7 with DR11 and DR12 was found to be associated with Balanitis xerotica obliterans
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| *Human papillomaviruses(HPV) was to been associated with childhood penile lichen sclerosus
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| ====Histopathology====
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| Early stage
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| Lymphocytic infiltrate in the epidermis and dermis, associated with basal vacuolar change in epidermis
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| epidermis becomes atrophic with surface hyperkeratosis.
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| development of the lesions, there is loss of elastic fibres in the papillary dermis and the dermal inflammatory infiltrate is displaced downwards by subepidermal oedema, which is subsequently replaced by fibrosis.
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| Late stage findings of penile lichen sclerosus include:
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| *thickened basement membrane
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| *subepidermal edema,which becomes more sclerotic over time
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| [[File:High magnification micrograph of lichen sclerosus, also lichen sclerosus et atrophicus. H&E stain. Related images Low mag. Intermed. mag. High mag. Very high mag..jpg|link=http://www.wikidoc.org/index.php/File:High%20magnification%20micrograph%20of%20lichen%20sclerosus,%20also%20lichen%20sclerosus%20et%20atrophicus.%20H&E%20stain.%20Related%20images%20Low%20mag.%20Intermed.%20mag.%20High%20mag.%20Very%20high%20mag..jpg|center|thumb|High magnification micrograph of '''lichen sclerosus''', also '''lichen sclerosus et atrophicus'''. H&E stain. Related images Low mag. Intermed. mag. High mag. Very high mag.]]
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| ====Zoon Balanitis====
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| Etiology and pathogenesis of Balanitis xerotica obliterans is not clearly known. Following theories have been postulated:
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| Accumlation of epithelial debris and secretions between foreskin and penis proximal to coronal sulcus, poor genital hygiene, repeated local infections, hot and humid weather results in chronic physical irritation or subclinical trauma, which in turn results in skin lesion along the lines the trauma.
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| ====Histopathology====
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| Epidermal changes
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| Early changes
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| thickening, acanthosis, and parakeratosis, which is followed by followed by epidermal atrophy.
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| epidermal atrophy, can be associated with erosions and spongiosis.
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| Additional features include:
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| subepidermal clefts
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| necrotic keratinocytes,
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| lozenge keratinocytes
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| Dermal changes include
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| Patchy infiltrate of lymphocytes and plasma cells in papillary dermis,
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| Lymphocytes are subsequently replaced by infiltrate of plasma cells, neutrophils, eosinophils, lymphocytes, and erythrocytes.
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| Vascular dilatation with singular vertical or oblique orientation of proliferated individual vessels, is characteristic feature of ZB.
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| In late stages, dermis shows fibrosis with subepidermal clefts, epidermal atrophy, and plasma cell infiltrates.
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| Pre-malignant
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| ==Causes==
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| {| class="wikitable" | | {| class="wikitable" |
| ! | | ! colspan="2" | |
| !
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| !
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| !
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| |-
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| |Infections
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| |Candidal Balanitis
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| |Anaerobic Balanitis
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| |Aerobic Balanitis
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| |Viral
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| |Parasitic
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| |-
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| |Non-infectious
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| |Circinate balanitis
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| |-
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| |Zoon's balanitis
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| |-
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| |Pemphigus
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| |-
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| |Pemphigoid
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| |-
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| |Pre-malignant conditions
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| |Erythroplasia of Queyrat (carcinoma in situ)
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| |-
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| |Bowen’s disease
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| |Bowenoid papulosis
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| |Miscellaneous
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| |Poor hygiene
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| |Trauma
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| |- | | |- |
| | |Infectious |
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| |Irritant
| | * Candida albicans |
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| | * Streptococci |
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| | * Anaerobes |
| | * Staphylococci |
| | * Trichomonas vaginalis |
| | * Herpes simplex virus |
| | * Human papillomavirus |
| | * Mycoplasma genitalium |
| |- | | |- |
| | |Inflammatory dermatoses |
| | | | | |
| |Contact dermatitis/allergy
| | * Lichen sclerosus |
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| | * Lichen planus |
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| | * Psoriasis and circinate balanitis |
| | * Zoon’s balanitis |
| | * Eczema (including irritant, allergic and seborrhoeic) |
| | * Allergic reactions (including fixed drug eruption and Stevens Johnson Syndrome) |
| |- | | |- |
| | |Premalignant (penile carcinoma in situ) |
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| |Fixed drug eruptions
| | * Bowen’s disease |
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| | * Bowenoid papulosis |
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| | * Erythroplasia of Queyrat |
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| |Reactive arthritis
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| |} | | |} |
| ==Differentiating differenting types of balanitis==
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| ==Epidemiology and Demographics==
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| ==Risk Factors==
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| Risk factors for Balanitis include:
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| *Uncircumcised penis
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| *Antibiotic use
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| *Corticosteroid use
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| *Immunocompromised
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| *Diabetes
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| *
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| *Not usually considered sexually transmitted
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| ==Screening==
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| There are no screening procedures for Balanitis.
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| ==Natural History, Complications and Prognosis==
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| ===Natural History===
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| ===Prognosis===
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| ===Complications===
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| Long-term inflammation or infection can:
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| *Scar and narrow the opening of the penis (meatal stricture)
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| *Make it difficult and painful to retract the foreskin to expose the tip of the penis (a condition called phimosis)
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| *Make it difficult to move the foreskin over the head of the penis (a condition called paraphimosis)
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| *Affect the blood supply to the tip of the penis
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| *Increase the risk of penile cancer
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| ==Diagnosis==
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| ===History and Symptoms===
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| Common symptoms of balanitis include:
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| *Redness of foreskin or penis
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| *Pruritus
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| *Other rashes on the head of the penis
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| *Foul-smelling discharge
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| *Painful penis and foreskin
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| ===Physical Examination===
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| [[File:Inflammation of the glans penis and the preputial mucosa.jpg|center|thumb]]
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| {| class="wikitable"
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| !
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| !History, symptoms and associations
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| !Physical examination
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| !laboratory findings
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| !Medical therapy
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| !Surgical therapy
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| !Primary prevention
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| !Secondary prevention
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| |-
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| |Candidal balanitis
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| |Culture:
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| potassium hydroxide (KOH) slide:
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| |Clotrimazole topical cream applied bid for 10-14 days
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| OR
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| Miconazole topical cream applied bid for 10-14 days
| | == Differential Diagnosis == |
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| |Balanitis due to poor hydiene
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| |Balanitis due to allergy or dermatitis
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| |Balanitits due to anerobic infectious
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| |Balanitits due to reactive arthritis
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| |Balanitis due to fixed drug eruption
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| |Balanitis xerotica obliterans
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| |Zoon balanitis
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| |carbon dioxide laser as an alternative therapy
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| |Carcinoma in situ
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| |}
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| {| class="wikitable"
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| ! colspan="4" |
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| !
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| !
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| !
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| !
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| !
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| !
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| !
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| |-
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| |Candidal balanitis
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| |Poor hygiene
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| |Dermatitis/allergy
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| |Anaerobic
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| |aerobic infections
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| |Reactive arthritis
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| |Fixed drug eruption
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| |balanitis xerotica obliterans
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| |Zoon balanitis
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| |Carcinoma in situ
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| |-
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| |History and symptoms
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| |Associated findings
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| |Physical examination finding
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| |Laboratory finding
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| |medical therapy
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| |Surgical therapy
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| |Primary prevention
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| |Secondary prevention
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| |}
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| == References == | | == References == |
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
Classification
|
|
| Infectious
|
- Candida albicans
- Streptococci
- Anaerobes
- Staphylococci
- Trichomonas vaginalis
- Herpes simplex virus
- Human papillomavirus
- Mycoplasma genitalium
|
| Inflammatory dermatoses
|
- Lichen sclerosus
- Lichen planus
- Psoriasis and circinate balanitis
- Zoon’s balanitis
- Eczema (including irritant, allergic and seborrhoeic)
- Allergic reactions (including fixed drug eruption and Stevens Johnson Syndrome)
|
| Premalignant (penile carcinoma in situ)
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- Bowen’s disease
- Bowenoid papulosis
- Erythroplasia of Queyrat
|
Differential Diagnosis
References