Balanitis is a topic covered in the Johns Hopkins ABX Guide.

To view the entire topic, please or purchase a subscription.

Official website of the Johns Hopkins Antibiotic (ABX), HIV, Diabetes, and Psychiatry Guides, powered by Unbound Medicine. Johns Hopkins Guide App for iOS, iPhone, iPad, and Android included. Explore these free sample topics:

Johns Hopkins Guides

-- The first section of this topic is shown below --

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 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. Bx 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 brown shiny patches with red specks.
        • May resemble 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).

-- To view the remaining sections of this topic, please or purchase a subscription --

Last updated: April 2, 2019