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
ICD-O	/bæləˈnaɪtɪs/;[1][2]
DiseasesDB	1229
MedlinePlus	000862
eMedicine	emerg/51
Patient UK	Balanitis
MeSH	D001446

Balanitis is inflammation of the glans penis.^[3] When the foreskin is also affected, it is termed balanoposthitis.^[3]

Balanitis on boys still in diapers must be distinguished from redness caused by ammoniacal dermatitis.^[4] The word is from the Greek βάλανος balanos "acorn".

Signs and symptoms

Symptoms 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.^[5]

Cause

Inflammation has many possible causes, including irritation by environmental substances, physical trauma, and infection such as bacterial, viral, or fungal.^[6][7] Some of these infections are sexually transmitted diseases.

It is less common among people who are circumcised as in many cases the foreskin contributes to the disease.^[3] Both not enough cleaning and too much cleaning can cause problems.^[3] Diabetes can make balanitis more likely, especially if the blood sugar is poorly controlled.^[8]

It is important to exclude other causes of similar symptoms such as penile cancer.^[3]

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.^[6]

Types

• Zoon's balanitis also known as Balanitis Circumscripta Plasmacellularis or plasma cell balanitis (PCB) is an idiopathic, rare, benign penile dermatosis^[9] for which circumcision is often the preferred treatment.^[9][10][11] Zoon's balanitis has been successfully treated with the carbon dioxide laser^[12] and more recently Albertini and colleagues report the avoidance of circumcision and successful treatment of Zoon's balanitis with an Er:YAG laser.^[13] Another study, by Retamar and colleagues, found that 40 percent of those treated with CO₂ laser relapsed.^[14]
• Circinate balantitis (also known as balanitis circinata) is a serpiginous annular dermatitis associated with reactive arthritis.
• Pseudoepitheliomatous keratotic and micaceous balanitis

Treatment

Initial treatment in adults often involves pulling back the foreskin and cleaning the penis.^[3]

Epidemiology

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".^[15]

Other animals

Prepuce of a dog affected by balanoposthitis

In dogs, balanoposthitis is caused by a disruption in the integumentary system, such as a wound or intrusion of a foreign body. A dog with this condition behaves normally, with the exception of excessive licking at the prepuce, and a yellow green, pus-like discharge is usually present. In sheep (rams/wethers), ulcerative enzootic balanoposthitis is caused by the Corynebacterium renale group (C. renale, C. pilosum & C. cystidis). For the condition in bulls, caused by a virus see Bovine herpesvirus 1. Balanoposthitis is believed to have contributed to the decline to near-extinction of Gilbert's potoroo.^[16]

References

1. OED 2nd edition, 1989.
2. Entry "balanitis" in Merriam-Webster Online Dictionary.
3. Edwards, SK; Bunker, CB; Ziller, F; van der Meijden, WI (August 2014). "2013 European guideline for the management of balanoposthitis.". International journal of STD & AIDS 25 (9): 615–26. PMID 24828553. Balanitis is uncommon in circumcised men and in many cases preputial dysfunction is a causal or contributing factor.
4. Simpson ET, Barraclough P (1998). "The management of the paediatric foreskin". Aust Fam Physician 27 (5): 381–3. PMID 9613002.
5. Phimosis at eMedicine
6. Edwards S (1996). "Balanitis and balanoposthitis: a review". Genitourin Med 72 (3): 155–9. doi:10.1136/sti.72.3.155. PMC 1195642. PMID 8707315.
7. Cleveland Clinic: Penile Disorders
8. Balanitis. Health Line. Retireved 19 April 2016.
9. Keogh G. Balanitis circumscripta plasmacellularis at eMedicine
10. 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. PMID 10101891.
11. 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.
12. Baldwin HE, Geronemus RG (1989). "The treatment of Zoon's balanitis with the carbon dioxide laser". J Dermatol Surg Oncol 15 (5): 491–4. doi:10.1111/j.1524-4725.1989.tb03407.x. PMID 2497162.
13. 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.
14. 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.
15. Balanitis at eMedicine
16. Rebecca Vaughan-Higgins, Nicky Buller, J. Anthony Friend, Ian Robertson, Cree L. Monaghan, Stan Fenwick, and Kristin Warren (2011) Balanoposthitis, Dyspareunia, and Treponema in the Critically Endangered Gilbert's Potoroo (Potorous gilbertii). Journal of Wildlife Diseases: October 2011, Vol. 47, No. 4, pp. 1019-1025.

External links

• 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.
• Dermatological atlas