Balanitis

Balanitis
Classification and external resources
Inflammation of the glans penis and the preputial mucosa
ICD-10	N48.1
ICD-9	607.1
DiseasesDB	1229
MedlinePlus	000862
eMedicine	emerg/51
MeSH	D001446

Balanitis (from Greek: βάλανος balanos "acorn") is inflammation of the glans penis . When the foreskin (or prepuce) is also affected, it is termed balanoposthitis. Balanitis on boys still in diapers must be distinguished from the normal redness seen in boys caused by ammoniacal dermatitis.^[1]

Etiology and epidemiology

Inflammation has many possible causes, including irritation by environmental substances, physical trauma, and infection by a wide variety of pathogens, including bacteria, virus, or fungus—each of which require a particular treatment.^[2]

O'Farrell et al. report that failure to wash the whole penis, including retraction of the foreskin in uncircumcised men, is more common among balanitis sufferers.^[3] Birley et al., however, found that excessive genital washing with soap may be a strong contributing factor to balanitis. ^[4] Diabetes can make balanitis more likely, especially if the blood sugar is poorly controlled.

Balanitis on an uncircumcised penis

In a study by Fergusson et al., penile inflammation was reported in 7.6 cases per 100 boys at risk in circumcised boys, and 14.4 cases per 100 boys at risk among uncircumcised boys.^[5] Herzog and Alvarez reported that, in their study, "[both] balanitis (6% vs 3%) and irritation (4% vs 1%) were more frequent among the uncircumcised children, but the difference was not statistically significant."^[6] Van Howe found that circumcised boys need to be as or more closely monitored for balanitis than uncircumcised boys.^[7] In Wilson's study, all 22 cases of balanitis were among uncircumcised men. However, the number of cases was "too small to be of significance".^[8] In a retrospective study including 28 cases of monilial balanitis, Taylor and Rodin found this condition to be more common among uncircumcised men.^[9] In a study assessing the effects of a war environment on sexual health, Hart reported that balanitis was "almost entirely confined to the uncircumcised".^[10] In a cross-sectional study of 398 patients, Fakjian et al. reported that balanitis was diagnosed in 12.5% of uncircumcised men and 2.3% of circumcised men.^[11] In a study of 225 men, O'Farrell et al. found that circumcised men were less likely to be diagnosed with balanitis than uncircumcised men.^[3] In Mallon's study of 357 patients with genital skin diseases and 305 controls, most cases of inflammatory penile dermatoses (and all patients with nonspecific balanoposthitis) were uncircumcised.^[12]

Prevalence

According to Leber, 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".^[13]

Escala and Rickwood, in a 1989 examination of 100 cases of balanitis in childhood, concluded that the risk "in any individual, uncircumcised boy appears to be no greater than 4%.".^[14] Øster reported no balanitis in 9545 observations of uncircumcised Danish boys.^[15]

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.^[2]

Symptoms

Symptoms usually begin to appear after 3 days and can include:

(1) First signs – small red erosions on the glans

(2) Redness of the foreskin

(3) Redness of the penis

(4) Other rashes on the head of the penis

(5) Foul smelling discharge

(6) Painful foreskin and penis

Complications

Recurrent bouts of balanitis may cause scarring of the preputial orifice; the reduced elasticity may lead to pathologic phimosis.^[16]

Types

• Zoon's balanitis also known as Balanitis Circumscripta Plasmacellularis or plasma cell balanitis (PCB) is an idiopathic, rare, benign penile dermatosis^[17] for which circumcision is often the preferred treatment.^[17][18][19] Zoon's balanitis has been successfully treated with the carbon dioxide laser^[20] and more recently Albertini and colleagues report the avoidance of circumcision and successful treatment of Zoon's balanitis with an Er:YAG laser.^[21] Another study, by Retamar and colleagues, found that 40 percent of those treated with CO₂ laser relapsed.^[22]
• Circinate balantitis (also known as balanitis circinata) is a serpiginous annular dermatitis associated with Reiter's syndrome.
• Pseudoepitheliomatous keratotic and micaceous balanitis

See also

• Penis
• Glans penis
• Foreskin
• Inflammation
• Circumcision
• Balanitis xerotica obliterans
• List of cutaneous conditions

References

1. ^ Simpson ET, Barraclough P (1998). "The management of the paediatric foreskin". Aust Fam Physician 27 (5): 381–3. PMID 9613002. http://www.cirp.org/library/hygiene/simpson1/. 
2. ^ ^{a b} Edwards S (1996). "Balanitis and balanoposthitis: a review". Genitourin Med 72 (3): 155–9. PMC 1195642. PMID 8707315. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1195642. 
3. ^ ^{a b} O'Farrell N, Quigley M, Fox P (2005). "Association between the intact foreskin and inferior standards of male genital hygiene behaviour: a cross-sectional study". Int J STD AIDS 16 (8): 556–9. doi:10.1258/0956462054679151. PMID 16105191. "Overall, circumcised men were less likely to be diagnosed with a STI/balanitis (51% and 35%, P 1⁄4 0.021) than those non-circumcised" 
4. ^ Birley HD, Walker MM, Luzzi GA et al. (1993). "Clinical features and management of recurrent balanitis; association with atopy and genital washing". Genitourin Med 69 (5): 400–3. PMC 1195128. PMID 8244363. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1195128. 
5. ^ Fergusson DM, Lawton JM, Shannon FT (1988). "Neonatal circumcision and penile problems: an 8-year longitudinal study". Pediatrics 81 (4): 537–41. PMID 3353186. http://www.circs.org/library/fergusson/. 
6. ^ Herzog LW, Alvarez SR (1986). "The frequency of foreskin problems in uncircumcised children". Am. J. Dis. Child. 140 (3): 254–6. PMID 3946358. http://www.circs.org/library/herzog/. 
7. ^ Van Howe RS (1997). "Variability in penile appearance and penile findings: a prospective study". Br J Urol 80 (5): 776–82. PMID 9393302. http://www.cirp.org/library/complications/vanhowe/. 
8. ^ Wilson RA. (1947). "CIRCUMCISION AND VENEREAL DISEASE". Can Med Assoc J 56 (1): 54–6. PMC 1583341. PMID 20277522. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1583341. 
9. ^ Taylor PK, Rodin P (August 1975). "Herpes genitalis and circumcision". Br J Vener Dis 51 (4): 274–7. PMC 1046564. PMID 1156848. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1046564. 
10. ^ Hart G (February 1974). "Factors influencing venereal infection in a war environment". Br J Vener Dis 50 (1): 68–72. PMC 1044980. PMID 4406089. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1044980. 
11. ^ Fakjian, N; S Hunter, GW Cole and J Miller (August 1990). "An argument for circumcision. Prevention of balanitis in the adult". Arch Dermatol 126 (8): 1046–7. doi:10.1001/archderm.126.8.1046. PMID 2383029. 
12. ^ Mallon E, Hawkins D, Dinneen M et al. (March 2000). "Circumcision and genital dermatoses". Arch Dermatol 136 (3): 350–4. doi:10.1001/archderm.136.3.350. PMID 10724196. 
13. ^ Balanitis at eMedicine
14. ^ Escala JM, Rickwood AM (1989). "Balanitis". Br J Urol 63 (2): 196–7. doi:10.1111/j.1464-410X.1989.tb05164.x. PMID 2702407. http://www.cirp.org/library/disease/balanitis/escala1/. 
15. ^ Øster J (1968). "Further fate of the foreskin. Incidence of preputial adhesions, phimosis, and smegma among Danish schoolboys". Arch. Dis. Child. 43 (228): 200–3. doi:10.1136/adc.43.228.200. PMC 2019851. PMID 5689532. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2019851. 
16. ^ Phimosis at eMedicine
17. ^ ^{a b} Keogh G. Balanitis circumscripta plasmacellularis at eMedicine
18. ^ Pellicé i Vilalta C, Casalots i Casado J, Cosme i Jiménez MA (1999). "[Zoon's balanoposthitis. A preliminary note]" (in Spanish; Castilian). Arch. Esp. Urol. 52 (1): 69–72. PMID 10101891. 
19. ^ Buechner SA (2002). "Common skin disorders of the penis". BJU Int. 90 (5): 498–506. doi:10.1046/j.1464-410X.2002.02962.x. PMID 12175386. http://www.blackwell-synergy.com/openurl?genre=article&sid=nlm:pubmed&issn=1464-4096&date=2002&volume=90&issue=5&spage=498. 
20. ^ Baldwin HE, Geronemus RG (1989). "The treatment of Zoon's balanitis with the carbon dioxide laser". J Dermatol Surg Oncol 15 (5): 491–4. PMID 2497162. http://www.cirp.org/library/disease/balanitis/baldwin1/. 
21. ^ Albertini JG, Holck DE, Farley MF (2002). "Zoon's balanitis treated with Erbium:YAG laser ablation". Lasers Surg Med 30 (2): 123–6. doi:10.1002/lsm.10037. PMID 11870791. 
22. ^ Retamar RA, Kien MC, Chouela EN (2003). "Zoon's balanitis: presentation of 15 patients, five treated with a carbon dioxide laser". Int. J. Dermatol. 42 (4): 305–7. doi:10.1046/j.1365-4362.2003.01304.x. PMID 12694501. http://www.blackwell-synergy.com/openurl?genre=article&sid=nlm:pubmed&issn=0011-9059&date=2003&volume=42&issue=4&spage=305. 

External links

• Balanitis - InteliHealth
• Zoon's Balanitis at eMedicine
• 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.

Images of balanitis

• Pictures of Balanitis
• STD services
• Dermatological atlas