Sandbox: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 Infectious balanitis

• Please click here to know more about Penile carcinoma in situ causing Balanitis
• Please click here to know more about Inflammatory deramtosis causing Balanitis
• 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 balanitis involve foreskin and prepuce it is termed balanoposthitis. Causes of balanitis can be mainly categorized into 1) Infectious 2) Inflammatory dermatoses 3) Penile carcinoma in situ.

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

2008 UK National Guideline on the Management of Balanoposthitis 

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 pathyway 2) Erythromycin 500 bd 3) Potent steroid cream

Differential Diagnosis

	Key History	Clinical appearance	Biopsy
Candida		Erythematous rash with soreness and/or itch, blotchy erythema with small papules which may be eroded, or dry dull red areas with a glazed appearance
Anaerobic Infection		Foul smelling sub-preputial inflammation and discharg: in severe cases associated with swelling and inflamed inguinal lymph nodes Preputial edema, superficial erosions: milder forms also occur
Aerobic Infection		Variable inflammatory changes including uniform erythema and edema
Trichomonas vaginalis		Superficial erosive balanitis which may lead to phimosis
Treponema paliidum		Multiple circinate lesions which erode to cause irregular ulcers have been described in the late primary or early secondary stage. A primary chancre may also be present
Herpes simplex		Grouped vesicles on erythematous base over glans, prepuce and shaft which rupture to form shallow erosins. In rare cases primary herpes can cause a necrotic balanitis, with necrotic areas on the glans accompained by vesicles elsewhere and associated with headache and malaise.
Human papilloma virus		Papilloma virus may be associated with patchy or chronic balanitis, which becomes acetowhite after the application of 5% acetic acid
Lichen sclerosus
Lichen Planus
Psoriasis
Circinate
Zoon's balanitis
Eczema
Allergic reaction
Bowen's disease
Bowenoid papulosis
Erythroplasia of Queyrat