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Zoon's balanitis, or plasma cell balanitis, is a chronic erosive process of the uncircumcised penis. The lesions are often refractory to conservative topical and surgical therapy and frequently require circumcision as a curative measure. This case report describes the first reported successful use of the carbon dioxide laser in the defocused mode to vaporize the chronic penile erosions of Zoon's balanitis.
Penile lesions from six patients with balanitis circinata were examined with the light and electron microscopes. The epithelium showed slight parakeratosis, acanthosis, and elongation of rete ridges. Neutrophil pustules occupied the upper epidermis. Prickle cells formed a spongiform net around the pustules. The most prominent features detected by the electron microscope were the small-to-medium-sized pustules in the upper epidermis. The thin flattened keratinocytes formed a sponge-like trabecular network. Neutrophils were not found inside the keratinocytes. Chlamydia were not present in the lesions, which indicates that balanitis circinata is due to some reactive mechanism. The fine structure of balanitis circinata resembles that of pustular psoriasis.
Men attending a genitourinary medicine clinic had an appreciably higher prevalence of subpreputial infection with group B streptococci (GBS) than with Staphylococcus aureus or coliform bacilli. Carriage of GBS was similar in older and younger age groups and was higher in homosexuals than heterosexuals and in those with balanitis than those without. Thus, while GBS may cause balanitis in heterosexuals, sexual transmission is unimportant; in contrast sexual transmission of GBS may be more common among homosexuals but balanitis is rare.
OBJECTIVE: To evaluate clinical features and diagnostic investigations in patients with recurrent or unresponsive balanitis in order to institute rational management. DESIGN: Forty-three patients presenting to a genitourinary medicine clinic with recurrent or persistent balanitis were studied. All patients were asked whether they had a history of atopic illness and about their practice of genital washing. All patients were investigated by taking a swab specimen from the preputial area for bacterial and viral culture and 30 underwent biopsy of the affected skin. Follow-up was between three and six months. SETTING: Outpatient genitourinary medicine clinic, St Mary's Hospital, London, UK. RESULTS: In 31 (72%) of the patients a diagnosis of irritant dermatitis was made. In comparison with the remaining patients, they had a greater lifetime incidence of atopic illness and more frequent daily genital washing with soap. For 28 (90%) of these patients, use of emollient creams and restriction of soap washing alone controlled symptoms satisfactorily. For the remaining 12 patients, a variety of diagnoses were made. Biopsy proved a well tolerated and diagnostic investigation, but the isolation of microbial pathogens from preputial swabs was irrelevant to management. CONCLUSION: A history of atopic illness and of the practice of penile washing are important aspects in the evaluation of patients with recurrent balanitis. Biopsy is an important investigation in the condition when it does not seem to be caused by irritant dermatitis.
One hundred fifty seven men with candidal balanitis were entered in a randomised, open-label parallel-group multicentre study comparing efficacy and safety of a single oral 150-mg fluconazole-dose with clotrimazole applied topically twice daily for 7 days. Of 64 fluconazole and 68 clotrimazole treated patients who were evaluable at short term follow up, 92% and 91% respectively were clinically cured or improved. Candida albicans was eradicated in 78% and 83% of patients respectively. Median time to relief of erythema was 6 days for fluconazole and 7 days for clotrimazole. Twelve of 15 patients who had received previous topical therapy for balanitis said they preferred oral therapy. At the one month follow up visit, 24/36 and 29/33 patients in the two groups were clinically cured or improved. Nine in the fluconazole group experienced a relapse; 6 of these 9 patients reported previous episodes of this infection during the past year. Two patients in the clotrimazole group had a relapse; neither had a history of previous episodes. Mycological eradication was noted in 26/36 and 25/33 patients in the two groups. Both treatment regimens were well tolerated. Thus a single 150 mg dose of fluconazole was comparable in efficacy and safety to clotrimazole cream applied topically for 7 days when administered to patients with balanitis.
The clinical presentation of candidal balanitis is discussed. Differential diagnosis from other forms of balanitis and dermatoses affecting the genitals is made. Treatment of candidal balanitis is then mentioned. General measures, contact investigation and specific measures such as the polyene antibiotics and the newer imidazole group of antifungal drugs are exemplified.
BACKGROUND: Balanitis xerotica obliterans is a subcategory of lichen sclerosus et atrophicus limited to the male genitalia and is associated with destructive inflammation, phimosis, urethral stenosis, and squamous cell carcinoma. METHODS: The medical literature was searched from 1983-1998 using key words balanitis, lichen, and sclerosis using the MEDLINE system. RESULTS AND CONCLUSIONS: Balanitis xerotica obliterans can be distinguished from other genital dermatoses with similar characteristics through patient history, clinical findings, and laboratory evaluation.. Tzanck smear and cutaneous biopsy, along with a rapid protein reagin test, will provide a definitive diagnosis. Treatment with high-dose topical corticosteroids relieves symptoms, and therapy focuses on prevention of disease progression.
Clinical cases presenting allergic contact balanitis from condoms are studied using a combination of patch testing and chemical analysis by gas chromatography and high-resolving liquid chromatography to identify the causative agents involved. It has been previously established that zinc ethylphenyl dithiocarbamate (ZEPC)--a dithiocarbamate-type accelerant (DTC)--is an etiological factor in the event of contact allergy to condoms. Later it is confirmed that DTCs, such as zinc dimethyl dithiocarbamate (ZDMC), zinc diethyl dithiocarbamate (ZDEC) and zinc dibutyl dithiocarbamate and amines, such as dimethylamine (DMA), diethylamine (DEA) and piperidine (PIP) are likewise implicated in condom-induced contact balanitis. As shown by the investigation along this line, although thiurams are believed to be more allergenic, as compared to the corresponding DTCs and amines, both DTCs (ZDMC, ZDEC, ZDBC, ZEPC) and amines (DMA, DEA and PIP) are noteworthy etiological factors of allergic contact balanitis from condoms.
Balanitis is an inflammation of the glans penis. There are several etiologic agents, including bacterial and yeast infections, parasitic infestations, and trauma or irritants. Plasma-cell balanitis and balanitis xerotica obliterans are two distinct clinical entities. The authors review the clinical and pathologic features and the treatment options for these conditions.
A case of pseudoerythroplasic vulvitis with histological features similar to purpuric telangiectasic and lichenoid balanitis is reported. The plasma cell infiltrate is usually discrete in these cases of chronic pseudoerythroplasic vulvitis and balanitis (CPVB). The authors suggest that these GPVB and Zoon's balanitis may represent different stages in the course of a same pathological process.
PURPOSE: A new technique for treating meatal stenosis due to balanitis xerotica obliterans was used. MATERIALS AND METHODS: Three patients with complete urinary retention and 1 with severe obstructive symptoms due to balanitis xerotica obliterans were treated with circumferential carbon dioxide laser vaporization of the urethral meatus. RESULTS: All 4 patients void spontaneously at 1 to 4.5 months of followup with peak flow rates of 1.25 to more than 3.0 standard deviations less than the mean normal peak flow rates at similar voided volumes. All patients are pleased with the postoperative results. CONCLUSIONS: Circumferential carbon dioxide laser vaporization monotherapy shows promise in treatment of meatal stenosis associated with balanitis xerotica obliterans.
This report is based on 7 children with balanitis xerotica obliterans. Of these patients 5 had stenosis of the urethral meatus that required meatotomy and the postoperative results were good. The frequency of balanitis xerotica obliterans in children at our center, as well as the findings of other authors, suggests that possibly more cases would be diagnosed during infancy if all dried foreskin were examined systematically.
The Lancefield group B streptococcus is a cause of serious genitourinary tract infections in peripartum women. However, it rarely has been implicated as a pathogen in genital infections of male subjects. We report severe recurrent balanitis owing to group B streptococcus in a sexually active young man. Group B streptococcus was cultured from the vagina of his asymptomatic consort on 1 occasion. It is postulated that penile cellulitis developed by invasion of group B streptococcus through a traumatic abrasion acquired during sexual intercourse. The preferred antibiotic treatment for balanitis caused by group B streptococcus is penicillin or erythromycin. Prevention of additional episodes may be difficult, since therapy of the female carrier state with antibiotics has not provided long-term eradication of group B streptococcus.
Balanitis xerotica obiterans is a chronic inflammatory process in male subjects, resulting in sclerotic epithelial changes of the glans penis, prepuce and urethral meatus individually or collectively. Four pediatric cases are presented, including the first case of balanitis xerotica obiterans invloving the glans penis and urethral meatus in a child. This lesion may be misdiagnosed or ignored in the young boy. The suggested method of treatment is surgical extirpation of the lesion when possible, wedge meatotomy when needed and sublesional corticosteroids if the lesion cannot be completely excised.
We have reported the case history of a patient with balanitis, who was treated with 5-FU. Although 5-FU has a wide toxicity profile, balanitis has not been reported in association with this therapy.
Two cases of pseudoepitheliomatous, micaceous and keratotic balanitis are presented and their clinical and histological features are discussed. This rare condition of the glans penis was originally thought to be benign, but more recent evidence indicates that the lesion is a manifestation of verrucous carcinoma. Consequently, the treatment of choice is excision with a wide margin. We suggest the new name, micaceous and verrucous malignant balanitis.
Twenty patients with histologically proven balantis xerotica obliterans have undergone different forms of treatment; their progress has been reviewed and discussed. Balanitis xerotica obliterans involving only the foreskin was best treated by circumcision. The patients in whom meatal stenosis was present responded well to regular meatal dilatation, meatotomy followed by regular dilatation and, in advanced cases, to meatoplasty. At present there is no evidence to indicate that associated urethral strictures, proximal to the fossa navicularis, are due to balanitis xerotica obliterans.
Zoon's balanitis is a chronic balanitis affecting parts of the glans penis and prepuce, usually considered refractory to treatment. This article reports the study of seven cases successfully treated by circumcision.