Balanitis: Inflammation of the Glans Penis
References: (Buechner, 2002) (Schütte, 2003).
Definition of Balanitis
A Balanitis is an infectious or non-infectious inflammation of the glans penis and the prepuce. The accurate medical term for a lesion involving glans and prepuce is balanoposthitis.
Etiology of Balanitis
Balanitis in children:
Balanitis in children usually arises from an infection of the smegma on the basis of a phimosis or non-retractile foreskin.
Balanitis caused by infection:
Candida, bacteria, viruses.Balanitis circinata:
erosive plaques with slightly raised edges on the glans due to a Reiter's syndrome.
1–4 weeks after urinary tract infection or intestinal infection patients may develop a Reiter's syndrome: fever, malaise, urethritis (95%), prostatitis (50–80%), conjunctivitis (50–90%), arthritis (knee, ankle, ISG in 30–50%), pustular rash developing small hard nodules called keratoderma blennorrhagica (palms, soles, leg, nail involvement). In 20–50% balanitis circinata. See also section non-gonococcal urethritis and fig. balanitis circinata.
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fig. balanitis circinata: erosive plaques on the glans due to Reiter's syndrome. Figure from Dr. Wiesner, Dr. Kaufman, Public Health Image Library, Center for Disease Control and Prevention, USA, www.cdc.gov. |
Balanitis in psoriasis:
Manifestation of psoriasis (inversa) of the glans penis.
Gangrenous balanitis:
Fournier gangrene at the glans penis [fig. gangrenous balanitis]. The untreated disease can lead to organ destruction.
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fig. Gangrenous balanitis: Fournier's gangrene of the glans penis. Figure from S. Lindsley, Public Health Image Library, Center for Disease Control and Prevention, USA, www.cdc.gov. |
Balanitis plasmazelluluaris (Zoon's disease):
Bright and sharply defined erythema of the glans. The inflammatory lesion of the glans of unknown etiology is rather asymptomatic. Histology shows a plasmacellular infiltrate. A biopsy should be obtained to rule out e.g. erythroplasia of Queyrat.
Balanitis xerotica obliterans (BXO):
manifestation of lichen sclerosus et atrophicans on the glans penis: porcelain white spots or papules on the glans with a sharp border. The atrophy leads to phimosis, meatal stenosis, urethral stricture of the fossa navicularis or, in females, to kraurosis vulvae. BXO is sporadically associated with squamous cell carcinoma.
Differential diagnosis of balanitis
Non-venereal sclerosing lymphangitis of the penis:
by frequent sexual intercourse or Balanitis are risk factors for a lymphangitis of the inner foreskin with cord-like indurations.
Behcet's disease:
chronic vasculitis with stomatitis (90%), iritis or conjunctivitis with hypopyon (30–90%), genital ulcers (60–90%), arthritis (20–60%), thrombophlebitis or erythema nodosum. The symptoms may alternate.
Erythroplasia Queyrat:
Squamous cell cancer in situ of the prepuce (or other non-keratinized squamous epithelium) is called erythroplasia Queyrat, whereas squamous cell cancer in situ of the skin is called Bowen's disease. Erythroplasia Queyrat is a well-defined bright redness of the glans and prepuce (or vulva, anus, mouth) with a fine granulation, slightly vulnerable [fig. erythroplasia Queyrat]. Slow progression in size. May be itchy. In 30% invasion into the dermis, metastases are then possible.
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fig. erythroplasia Queyrat: squamous cell carcinoma in situ (Bowen's disease) of the glans. Figure from S. Lindsley, Public Health Image Library, Center for Disease Control and Prevention, USA, www.cdc.gov. |
Diagnosis
In doubt of the etiology or resistance to standard care, a microbiological culture and/or biopsy should be obtained.
Treatment of Balanitis
- Penis baths and if necessary oral antibiotics in the acute inflammatory episode of bacterial balanitis
- Circumcision: treatment of phimosis or recurrent balanitis
- Further treatment according to the underlying disease
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References
- Buechner 2002 BUECHNER, S. A.:
- Common skin disorders of the penis.
In: BJU Int
90 (2002), Nr. 5, S. 498-506
- Schütte 2003 SCHüTTE, B.:
- Ausgewählte dermatologische Erkrankungen im Genitalbereich.
In: Urologe A
42 (2003), S. 514–522
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Deutsche Version: Balanitis: Entzündung der Eichel.
Last update:
Dr. med. Dirk Manski (E-Mail)