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Balanitis

 

Balanitis

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

Balanitis (;[1][2] from the Greek βάλανος (balanos "acorn") is inflammation of the glans penis. When the foreskin 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.[3]

Contents

  • Signs and symptoms 1
    • Complications 1.1
  • Cause 2
  • Diagnosis 3
    • Types 3.1
  • Epidemiology 4
  • References 5
  • External links 6
    • Images of balanitis 6.1

Signs and symptoms

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

  • First signs – small red erosions on the glans
  • 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.[4]

Cause

Inflammation has many possible causes, including irritation by environmental substances, physical trauma, and infection by a wide variety of pathogens, including bacteria, virus, sexually transmitted diseases, or fungus—each of which require a particular treatment.[5][6]

O'Farrell et al. (2005) reported that failure to wash the whole penis, including retraction of the foreskin, is more common among balanitis sufferers.[7] Birley et al. (1993), however, found that excessive genital washing with soap may be a strong contributing factor to the condition.[8] Diabetes can make balanitis more likely, especially if the blood sugar is poorly controlled.

Van Howe (1997) found that circumcised boys need to be as or more closely monitored for balanitis than uncircumcised boys.[9] In Wilson's study (1947) all 22 cases of balanitis were among men who were not circumcised, however the number of cases was "too small to be of significance".[10] In a retrospective study including 28 cases of monilial balanitis, Taylor and Rodin (1975) found this condition to be more common among men who had not been circumcised.[11] In a study assessing the effects of a war environment on sexual health, Hart (1974) reported that balanitis was "almost entirely confined to the uncircumcised".[12] In a cross-sectional study of 398 patients, Fakjian et al. (1990) reported that balanitis was diagnosed in 12.5% of uncircumcised men and 2.3% of circumcised men.[13] In a study of 225 men, O'Farrell et al. (2005) found that circumcised men were less likely to be diagnosed with balanitis than uncircumcised men.[7] In Mallon's study (2000) of 357 patients with genital skin diseases and 305 controls, most cases of inflammatory penile dermatoses (and all patients with nonspecific balanoposthitis) were in men not circumcised.[14]

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.[5]

Types

  • Zoon's balanitis also known as Balanitis Circumscripta Plasmacellularis or plasma cell balanitis (PCB) is an idiopathic, rare, benign penile dermatosis[15] for which circumcision is often the preferred treatment.[15][16][17] Zoon's balanitis has been successfully treated with the carbon dioxide laser[18] and more recently Albertini and colleagues report the avoidance of circumcision and successful treatment of Zoon's balanitis with an Er:YAG laser.[19] Another study, by Retamar and colleagues, found that 40 percent of those treated with CO2 laser relapsed.[20]
  • Circinate balantitis (also known as balanitis circinata) is a serpiginous annular dermatitis associated with reactive arthritis.
  • Pseudoepitheliomatous keratotic and micaceous balanitis

Epidemiology

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".[21]

References

  1. ^ OED 2nd edition, 1989.
  2. ^ Entry "balanitis" in Merriam-Webster Online Dictionary.
  3. ^ Simpson ET, Barraclough P (1998). "The management of the paediatric foreskin". Aust Fam Physician 27 (5): 381–3.  
  4. ^ Phimosis at eMedicine
  5. ^ a b Edwards S (1996). "Balanitis and balanoposthitis: a review". Genitourin Med 72 (3): 155–9.  
  6. ^ Cleveland Clinic: Penile Disorders
  7. ^ 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.  
  8. ^ 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.  
  9. ^ Van Howe RS (1997). "Variability in penile appearance and penile findings: a prospective study". Br J Urol 80 (5): 776–82.  
  10. ^ Wilson RA. (1947). "CIRCUMCISION AND VENEREAL DISEASE". Can Med Assoc J 56 (1): 54–6.  
  11. ^ Taylor PK, Rodin P (August 1975). "Herpes genitalis and circumcision". Br J Vener Dis 51 (4): 274–7.  
  12. ^ Hart G (February 1974). "Factors influencing venereal infection in a war environment". Br J Vener Dis 50 (1): 68–72.  
  13. ^ Fakjian, N; S Hunter; GW Cole; J Miller (August 1990). "An argument for circumcision. Prevention of balanitis in the adult". Arch Dermatol 126 (8): 1046–7.  
  14. ^ Mallon E; Hawkins D; Dinneen M; et al. (March 2000). "Circumcision and genital dermatoses". Arch Dermatol 136 (3): 350–4.  
  15. ^ a b Keogh G. Balanitis circumscripta plasmacellularis at eMedicine
  16. ^ Pellicé i Vilalta C, Casalots i Casado J, Cosme i Jiménez MA (1999). "[Zoon's balanoposthitis. A preliminary note]". Arch. Esp. Urol. (in Spanish) 52 (1): 69–72.  
  17. ^ Buechner SA (2002). "Common skin disorders of the penis". BJU Int. 90 (5): 498–506.  
  18. ^ Baldwin HE, Geronemus RG (1989). "The treatment of Zoon's balanitis with the carbon dioxide laser". J Dermatol Surg Oncol 15 (5): 491–4.  
  19. ^ Albertini JG, Holck DE, Farley MF (2002). "Zoon's balanitis treated with Erbium:YAG laser ablation". Lasers Surg Med 30 (2): 123–6.  
  20. ^ 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.  
  21. ^ Balanitis at eMedicine

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

  • STD services
  • Dermatological atlas
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