Balanitis Explained

Balanitis
Field:	Urology

Balanitis is inflammation of the glans penis. When the foreskin is also affected, the proper term is balanoposthitis. Balanitis on boys still in diapers must be distinguished from redness caused by ammoniacal dermatitis.^[1] The word balanitis is from the Greek βάλανος Greek, Modern (1453-);: balanos, literally meaning 'acorn', used because of the similarity in shape to the glans penis.^[2]

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

Complications

Recurrent bouts of balanitis may cause scarring of the preputial orifice; the reduced elasticity may lead to pathologic phimosis. Further complications may include:^[3]

• Stricture of urinary meatus
• Phimosis
• Paraphimosis

Cause

Inflammation has many possible causes, including irritation by environmental substances, certain medications, physical trauma, and infection such as bacterial, viral, or fungal.^{[4] [5]} Some of these infections are sexually transmitted.

It is less common among people who are circumcised, as in many cases, a dysfunction of the foreskin is a causal or contributing factor.^[6] Both not enough cleaning and too much cleaning can cause problems.^[6]

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.^[4]

Types

• Zoon's balanitis, also known as Balanitis Circumscripta Plasmacellularis or plasma cell balanitis (PCB), is an idiopathic, rare, benign penile dermatosis^[7] for which circumcision is often the preferred treatment.^{[7] [8] [9]} Zoon's balanitis has been successfully treated with the carbon dioxide laser; ^[10] and more recently, Albertini and colleagues report the avoidance of circumcision and successful treatment of Zoon's balanitis with an Er:YAG laser.^[11] Another study, by Retamar and colleagues, found that 40 percent of those treated with CO₂ laser relapsed.^[12]
• 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.^[6] However, some topical antibiotic and fungal ointments may be used for treatment for mild cases.Depending upon severity, hydrocortisone and other steroidal creams may be used upon consultation.

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".

Other animals

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.^[13]

Further reading

• Edwards S. (for the Clinical Effectiveness Group) National guideline on the management of balanitis. Association for Genitourinary Medicine (UK) and the Medical Society for the Study of Venereal Diseases (UK), 2001.

External links

• • Dermatological atlas

Notes and References

1. Simpson ET, Barraclough P . The management of the paediatric foreskin . Aust Fam Physician . 27 . 5 . 381–3 . 1998 . 9613002 .
2. .
3. https://www.clarewellclinics.co.uk/sexual-health-clinic/balanitis/
4. Edwards S . Balanitis and balanoposthitis: a review . Genitourin Med . 72 . 3 . 155–9 . 1996 . 8707315 . 1195642 . 10.1136/sti.72.3.155.
5. http://my.clevelandclinic.org/disorders/penile_disorders/hic_disorders_of_the_penis.aspx Cleveland Clinic: Penile Disorders
6. Edwards. SK. Bunker. CB. Ziller. F. van der Meijden. WI. 2013 European guideline for the management of balanoposthitis.. International Journal of STD & AIDS. August 2014. 25. 9. 615–26. 24828553. 10.1177/0956462414533099. 127341.
7. Keogh G.
8. Pellicé i Vilalta C, Casalots i Casado J, Cosme i Jiménez MA . [Zoon's balanoposthitis. A preliminary note] . es. Arch. Esp. Urol. . 52 . 1 . 69–72 . 1999 . 10101891 .
9. Buechner SA . Common skin disorders of the penis . BJU Int. . 90 . 5 . 498–506 . 2002 . 12175386 . 10.1046/j.1464-410X.2002.02962.x . 45605100 .
10. Baldwin HE, Geronemus RG . The treatment of Zoon's balanitis with the carbon dioxide laser . The Journal of Dermatologic Surgery and Oncology . 15 . 5 . 491–4 . 1989 . 2497162 . 10.1111/j.1524-4725.1989.tb03407.x.
11. Albertini JG, Holck DE, Farley MF . Zoon's balanitis treated with Erbium:YAG laser ablation . Lasers Surg Med . 30 . 2 . 123–6 . 2002 . 11870791. 10.1002/lsm.10037. 33098632 .
12. Retamar RA, Kien MC, Chouela EN . Zoon's balanitis: presentation of 15 patients, five treated with a carbon dioxide laser . Int. J. Dermatol. . 42 . 4 . 305–7 . 2003 . 12694501 . 10.1046/j.1365-4362.2003.01304.x . 21305117 .
13. Rebecca . Vaughan-Higgins . Nicky . Buller . J. Anthony . Friend . Ian . Robertson . Cree L. . Monaghan . Stan . Fenwick . Kristin . Warren . Balanoposthitis, Dyspareunia, and Treponema in the Critically Endangered Gilbert's Potoroo (Potorous gilbertii) . Journal of Wildlife Diseases . 2011 . 47 . 4 . 1019–1025 . 10.7589/0090-3558-47.4.1019 . 22102677 . 7279808 . free .