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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.
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.
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.
Clotrimazole 1% (Canesten) cream was used in a trial comprising 138 men with candidal balanitis. Eighty-six (91%) out of 94 men were asymptomatic after seven days and 57 (98%) of 58 men were asymptomatic after three weeks' treatment. After seven days, Candida albicans could no longer be cultured from 86 (90%) of 96 men, nor from 55 (95%) of 58 men three weeks after treatment. Microscopical examination gave varying results. Fifteen (10.9%) of 138 men were found to have diabetes mellitus; this group was significantly older than the non-diabetics. It is concluded that treatment with clotrimazole for seven days is effective in the treatment of candidal balanitis.
This is a special case of balanitis, that authors separate from entities clinically established such as Erthroplasie of Queyrat, Balanitis of Zoon, Liquenoide Balantis with Plasmocytes and the Balantis of Sulsberger and Garbe's illness. The V. P. T. B. is clinically characterized by the presence of telangiectasies, ertroplasiform aspect, without any infiltration, non purpure, the V. P. T. B. goes through a first period truly esythematous and a second one in which these is also desquamation. That cycle is completed in a month. At the histopathologic level, the most important characteristics are: epidermis with its Malpighian layer in a normal state, the basal layers showing hidropic degeneration. The repper dermis shows a lichenoid picture that, in certain places affects the basal layer. The infiltrate is composed of: lymphocytes, monocytes and plasmocytes. Numerous telangiectasies are also observed.
Significant ecologic changes in the cutaneous flora during treatment may present a challenge both diagnostically and therapeutically. The development of an erosive balanitis due to Pseudomonas aeruginosa presented an example of such a microbiologic shift in the case reported. The eruption developed during treatment with topical antibacterial, antifungal, and corticosteroid agents. The sudden exacerbation of any balanitis while under treatment should alert the physician to the possibility of superinfection.
The HL-A phenotype of 17 patients with a typical clinical picture of circinate erosive balanitis was determined. Eight of the patients had other signs of Reiter's disease and 9 had balanitis alone. HL-A 27 was found to be present in 15 of the 17 cases. One patient of each group lacked this antigen. The frequency of the other histocompatibility antigens did not significantly differ from that of a Finnish control population.
Balanitis xerotica obliterans (BXO) is known to affect the urethral meatus, glans, and prepuce. We describe a case of biopsy-proved BXO that involves not only the usual areas but the anterior urethra as well. Of added interest is the subsequent development of squamous cell carcinoma in the fossa navicularis. The literature is reviewed.
A case of primary syphilitic chancre of the coronal sulcus with subsequent development of syphilitic balanitis of Follmann is described. The histopathological picture and preponderantly intraepidermal localization of T. pallidum in the lesions is discussed.
Virological studies have proved herpes simplex virus type 2 to be the cause of the severe primary infection in a 37-year-old man with necrotising balanitis. Symptoms of urethritis preceded the appearance of a severe local lesion; dissemination of infection occurred and lesions developed on the skin of the scalp, neck, trunk, buttocks, arms, legs, and feet. No evidence of involvement of the central nervous system was found, and the penile and skin lesions improved rapidly after the application of 5% idoxuridine in dimethylsulphoxide. Recurrences occurred at various skin sites at six to seven months after the primary infection.
A clinical report of 5 cases of balanitis xerotica obliterans (BXO) with urethral involvement is presented. Involvement of the urethra in the BXO is emphasized and the fact that this process is often unnoticed, is stressed. The clinical and histological characteristics of this disease are described in its different localizations. Investigations are suggested to diagnose urethral involvement and the suitable therapy is outlined.
Balanitis xerotica obliterans (BXO) and kraurosis penis are thought to be synonymous. Clinically and histopathologically they probably represent the same disease process as lichen sclerosus et atrophicus (LSA) but also involve the urethral mucosa. The treatment of choice is considered to be 2 1/2% testosterone propionate ointment which gives better results than strong corticosteroid applications, yet without their side effects.
A peculiar anatomoclinic form is described about the Balanoposthite chronique circonscrite bénigne à plasmocytes (Zoon): the pimpled, erosive, nodular and pseudoangiomatous form. Clinically this balantis realizes a pseudo-oedematous infiltration (which belongs to the usual form) and especially botriomycome-like nodules (obs. 2) or pseudo-neoplastic tumors (obs. 1). Histologically, the lesions consist of a pure plasmocytar infiltration, with total disappearance of the epithelium. In spite of its pseudo-tumoral aspect and of the abundance of plasmocytes, this kind of balanitis is quite benign and chronic, may persist many years without transformation, and is never a sign of dysglobulinemia.
A personal technique is described for the surgical correction of balanic hypospadias. The result of this technique is a large neourethra and satisfactory esthetics in 1 operation.
The Candida hemagglutination test (Candida-HA-Test), the complement fixation, Candida immunofluorescent test (Candida-IF-Test) and the agglutination-test were performed in 34 patients suffering from genital candidosis and in 34 healthy controls. The results obtained were: Candida hemagglutination and complement fixation titers are raised to the same extent in patients suffering from Candida albicans-balanoposthitis when soluble polysaccharide antigens are used in both tests. The high titers indicate a great portion of mercaptoethanol susceptible antibodies in those subjects. When compared with controls, the hemagglutination titers are fourfold lower than those of the patients. There is a four-to-sixfold decrease of the hemagglutination titers performed after mercaptoethanol treatment of the sera in the patients. On the other hand, there is only a twofold decrease of hemagglutination titers in the controls. In chronically infected persons the hemagglutination titers are within the normal range or are raised insignificantly. There is only a twofold decrease in HA-titers after treatment of the sera with mercaptoethanol. On the other hand, the agglutination- and the Candida-IF-titers seem to be elevated as a rule in chronically infected. In those patients the gamma G- and the gamma A-titers are significantly raised, too. The results mentioned above are discussed with regard to their clinical significance.
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