Medicine:Balanitis

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Balanitis is inflammation of the glans penis.[1] Balanoposthitis is the proper term when the foreskin is also affected.[1] Balanitis on boys in diapers must be distinguished from redness caused by ammoniacal dermatitis.[2]

Etymology

The word balanitis is from the Greek βάλανος balanos, literally meaning 'acorn' because of the similarity in shape to the glans penis.[3] -Itis is a suffix from the Greek for 'inflammation'. Posthe is the Greek word meaning 'foreskin'.

Signs and symptoms

  • Small red erosions on the glans (first sign)
  • 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] Further complications may include:[5]

Causes

Balanitis caused by smegma

Inflammation has many possible causes, including irritation by environmental substances, certain medications, physical trauma, and infection such as bacterial, viral, or fungal.[6][7] Some of these infections are sexually transmitted, however a yeast infection, Candida balanitis, is generally not categorized as such.

It is less common among males who are circumcised; in many cases, a dysfunction of the foreskin is a causal or contributing factor.[1] Both not enough cleaning and too much cleaning can cause problems.[1]

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[8] for which circumcision is often the preferred treatment.[8][9][10] Zoon's balanitis has been successfully treated with the carbon dioxide laser; [11] and more recently, Albertini and colleagues report the avoidance of circumcision and successful treatment of Zoon's balanitis with an Er:YAG laser.[12] Another study, by Retamar and colleagues, found that 40 percent of those treated with CO2 laser relapsed.[13]
  • Circinate balanitis, 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 simply pulling back the foreskin and cleaning the penis.[1] However, some topical antibiotic and fungal ointments may be used for treatment for mild cases. Depending upon severity, hydrocortisone and other steroidal creams may be used upon consultation.

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".[14]

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 the marsupial Gilbert's potoroo.[15]

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 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. doi:10.1177/0956462414533099. PMID 24828553. 
  2. ↑ "The management of the paediatric foreskin". Aust Fam Physician 27 (5): 381–3. 1998. PMID 9613002. 
  3. ↑ βάλανος. Liddell, Henry George; Scott, Robert; A Greek–English Lexicon at the Perseus Project.
  4. ↑ Phimosis at eMedicine
  5. ↑ "Balanitis". https://www.clarewellclinics.co.uk/sexual-health-clinic/balanitis/. 
  6. ↑ 6.0 6.1 Edwards S (1996). "Balanitis and balanoposthitis: a review". Genitourin Med 72 (3): 155–9. doi:10.1136/sti.72.3.155. PMID 8707315. 
  7. ↑ Cleveland Clinic: Penile Disorders
  8. ↑ 8.0 8.1 Keogh G. Balanitis circumscripta plasmacellularis at eMedicine
  9. ↑ "[Zoon's balanoposthitis. A preliminary note]" (in es). Arch. Esp. Urol. 52 (1): 69–72. 1999. PMID 10101891. 
  10. ↑ 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. 
  11. ↑ "The treatment of Zoon's balanitis with the carbon dioxide laser". The Journal of Dermatologic Surgery and Oncology 15 (5): 491–4. 1989. doi:10.1111/j.1524-4725.1989.tb03407.x. PMID 2497162. 
  12. ↑ "Zoon's balanitis treated with Erbium:YAG laser ablation". Lasers Surg Med 30 (2): 123–6. 2002. doi:10.1002/lsm.10037. PMID 11870791. https://zenodo.org/record/1229277. 
  13. ↑ "Zoon's balanitis: presentation of 15 patients, five treated with a carbon dioxide laser". Int. J. Dermatol. 42 (4): 305–7. 2003. doi:10.1046/j.1365-4362.2003.01304.x. PMID 12694501. 
  14. ↑ Balanitis at eMedicine
  15. ↑ Vaughan-Higgins, Rebecca; Buller, Nicky; Friend, J. Anthony; Robertson, Ian; Monaghan, Cree L.; Fenwick, Stan; Warren, Kristin (2011). "Balanoposthitis, Dyspareunia, and Treponema in the Critically Endangered Gilbert's Potoroo (Potorous gilbertii)". Journal of Wildlife Diseases 47 (4): 1019–1025. doi:10.7589/0090-3558-47.4.1019. PMID 22102677. http://researchrepository.murdoch.edu.au/id/eprint/6136/. 

Further reading

Classification
External resources



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