Balanitis

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.

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

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