Balanitis

Paul G. Auwaerter, M.D.
Balanitis is a topic covered in the Johns Hopkins ABX Guide.

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CLINICAL

  • Definition: a descriptive term for inflamed glans penis +/- prepuce (which is termed prosthitis, both = balanoposthitis).
  • Causes/associations: infection, diabetes mellitus (check serum or urine glucose as may be initial presentation), poor hygiene (uncircumcised), chemical irritants (soap, petroleum jelly), anasarca, drugs, morbid obesity, penile CA.
    • Uncommon in circumcised men.
  • Hx: tender glans, discharge, difficult to retract prepuce +/- impotence/difficult urination.
    • Take sexual history.
    • Poor hygiene is often a predisposing factor.
  • PE: penile erythema/edema/ulcers/plaques +/- discharge +/- phimosis.
    • Signs and symptoms vary according to etiology.
  • Various types:
    • Infection:
    • Inflammatory dermatoses:
      • Circinate: a manifestation of reactive arthritis (formerly Reiter’s syndrome).
        • Bx - spongiform pustules, maybe chlamydia probe positive.
      • Psoriasis
      • Irritant/allergic/eczematous: secondary to condoms? diaphragms, lubricants/spermicides, etc. Hx atopy is common.
        • Patch testing.
        • A biopsy is nonspecific.
      • Fixed drug eruptions: medication hx (tetracycline, sulfa, PCN, salicylates, phenacetin, phenolphthalein, some hypnotics), + oral/ocular mucosa lesions.
        • Rechallenge to confirm dx.
      • Lichen sclerosus (balanitis xerotica obliterans):
        • Dx by biopsy. Associated with squamous cell CA in 4-6% of patients. 1% risk of malignant transformation. Annual f/u needed.
      • Lichen planus
      • Zoon’s (plasma cell): pinpoint red spots, "cayenne pepper spots" (typical appearance) or bright red or shiny brown patches with red specks.
        • It may resemble the erythroplasia of Queyrat.
        • Dx by biopsy.
    • Premalignant conditions:
      • Erythroplasia of Queyrat:
        • Biopsy shows squamous cell carcinoma in situ.
      • Bowenoid papulosis
      • Bowen’s disease
        • Sometimes referred to as squamous cell carcinoma in situ.
  • Ddx: leukoplakia, lichen planus, psoriasis, seborrheic dermatitis, pemphigus, dermatitis artefacta, Bowen’s disease, Bowenoid papulosis.
  • If not responsive to initial therapy, involve dermatology or urology consultants for consideration of biopsy (rule-out penile CA, pre-malignant lesion).

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CLINICAL

  • Definition: a descriptive term for inflamed glans penis +/- prepuce (which is termed prosthitis, both = balanoposthitis).
  • Causes/associations: infection, diabetes mellitus (check serum or urine glucose as may be initial presentation), poor hygiene (uncircumcised), chemical irritants (soap, petroleum jelly), anasarca, drugs, morbid obesity, penile CA.
    • Uncommon in circumcised men.
  • Hx: tender glans, discharge, difficult to retract prepuce +/- impotence/difficult urination.
    • Take sexual history.
    • Poor hygiene is often a predisposing factor.
  • PE: penile erythema/edema/ulcers/plaques +/- discharge +/- phimosis.
    • Signs and symptoms vary according to etiology.
  • Various types:
    • Infection:
    • Inflammatory dermatoses:
      • Circinate: a manifestation of reactive arthritis (formerly Reiter’s syndrome).
        • Bx - spongiform pustules, maybe chlamydia probe positive.
      • Psoriasis
      • Irritant/allergic/eczematous: secondary to condoms? diaphragms, lubricants/spermicides, etc. Hx atopy is common.
        • Patch testing.
        • A biopsy is nonspecific.
      • Fixed drug eruptions: medication hx (tetracycline, sulfa, PCN, salicylates, phenacetin, phenolphthalein, some hypnotics), + oral/ocular mucosa lesions.
        • Rechallenge to confirm dx.
      • Lichen sclerosus (balanitis xerotica obliterans):
        • Dx by biopsy. Associated with squamous cell CA in 4-6% of patients. 1% risk of malignant transformation. Annual f/u needed.
      • Lichen planus
      • Zoon’s (plasma cell): pinpoint red spots, "cayenne pepper spots" (typical appearance) or bright red or shiny brown patches with red specks.
        • It may resemble the erythroplasia of Queyrat.
        • Dx by biopsy.
    • Premalignant conditions:
      • Erythroplasia of Queyrat:
        • Biopsy shows squamous cell carcinoma in situ.
      • Bowenoid papulosis
      • Bowen’s disease
        • Sometimes referred to as squamous cell carcinoma in situ.
  • Ddx: leukoplakia, lichen planus, psoriasis, seborrheic dermatitis, pemphigus, dermatitis artefacta, Bowen’s disease, Bowenoid papulosis.
  • If not responsive to initial therapy, involve dermatology or urology consultants for consideration of biopsy (rule-out penile CA, pre-malignant lesion).

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Last updated: February 7, 2023