Balanitis
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CLINICAL
- Definition: a descriptive term for inflamed glans penis +/- prepuce (which is termed prosthitis, both = balanoposthitis).
- Causes/associations: infection, diabetes mellitus (check serum or urine glucose as may be initial presentation), poor hygiene (uncircumcised), chemical irritants (soap, petroleum jelly), anasarca, drugs, morbid obesity, penile CA.
- Uncommon in circumcised men.
- Hx: tender glans, discharge, difficult to retract prepuce +/- impotence/difficult urination.
- Take sexual history.
- Poor hygiene often a predisposing factor.
- PE: penile erythema/edema/ulcers/plaques +/- discharge +/- phimosis.
- Signs and symptoms vary according to etiology.
- Various types:
- Infection:
- Candida: KOH prep and fungal culture.
- Aerobic: cx for streptococci/staphylococci/Gardnerella (r/o syphilis/trichomonas/HSV).
- Anaerobic: foul-smelling discharge, edema + lymphadenopathy. Gram stain will show mixed flora, polymicrobial cx.
- HPV: typical pathology with warts possible.
- Trichomonas vaginalis
- Herpes simplex virus
- Mycoplasma genitalium
- Inflammatory dermatoses:
- Circinate: a manifestation of reactive arthritis (formerly Reiter’s syndrome).
- Bx - spongiform pustules, maybe chlamydia probe positive.
- Psoriasis
- Irritant/allergic/eczematous: secondary to condoms ?, diaphragms, lubricants/spermicides, etc. Hx atopy is common. Patch testing. Bx nonspecific.
- Fixed drug eruptions: medication hx (tetracycline, sulfa, PCN, salicylates, phenacetin, phenolphthalein, some hypnotics), + oral/ocular mucosa lesions.
- Rechallenge to confirm dx.
- Lichen sclerosus (balanitis xerotica obliterans):
- Dx by biopsy. Associated with squamous cell CA in 4-6% of patients. 1% risk of malignant transformation. Annual f/u needed.
- Lichen planus
- Zoon’s (plasma cell): pinpoint red spots "cayenne pepper spots" (typical appearance) or bright red or brown shiny patches with red specks.
- May resemble erythroplasia of Queyrat. Dx by biopsy.
- Circinate: a manifestation of reactive arthritis (formerly Reiter’s syndrome).
- Premalignant conditions:
- Erythroplasia of Queyrat:
- Biopsy shows squamous cell carcinoma in situ.
- Bowenoid papulosis
- Bowen’s disease
- Sometimes referred to as squamous cell carcinoma in situ.
- Erythroplasia of Queyrat:
- Infection:
- Ddx: leukoplakia, lichen planus, psoriasis, seborrheic dermatitis, pemphigus, dermatitis artefacta, Bowen’s disease, Bowenoid papulosis.
- If not responsive to initial therapy, involve dermatology or urology consultants for consideration of biopsy (rule-out penile CA, pre-malignant lesion).
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CLINICAL
- Definition: a descriptive term for inflamed glans penis +/- prepuce (which is termed prosthitis, both = balanoposthitis).
- Causes/associations: infection, diabetes mellitus (check serum or urine glucose as may be initial presentation), poor hygiene (uncircumcised), chemical irritants (soap, petroleum jelly), anasarca, drugs, morbid obesity, penile CA.
- Uncommon in circumcised men.
- Hx: tender glans, discharge, difficult to retract prepuce +/- impotence/difficult urination.
- Take sexual history.
- Poor hygiene often a predisposing factor.
- PE: penile erythema/edema/ulcers/plaques +/- discharge +/- phimosis.
- Signs and symptoms vary according to etiology.
- Various types:
- Infection:
- Candida: KOH prep and fungal culture.
- Aerobic: cx for streptococci/staphylococci/Gardnerella (r/o syphilis/trichomonas/HSV).
- Anaerobic: foul-smelling discharge, edema + lymphadenopathy. Gram stain will show mixed flora, polymicrobial cx.
- HPV: typical pathology with warts possible.
- Trichomonas vaginalis
- Herpes simplex virus
- Mycoplasma genitalium
- Inflammatory dermatoses:
- Circinate: a manifestation of reactive arthritis (formerly Reiter’s syndrome).
- Bx - spongiform pustules, maybe chlamydia probe positive.
- Psoriasis
- Irritant/allergic/eczematous: secondary to condoms ?, diaphragms, lubricants/spermicides, etc. Hx atopy is common. Patch testing. Bx nonspecific.
- Fixed drug eruptions: medication hx (tetracycline, sulfa, PCN, salicylates, phenacetin, phenolphthalein, some hypnotics), + oral/ocular mucosa lesions.
- Rechallenge to confirm dx.
- Lichen sclerosus (balanitis xerotica obliterans):
- Dx by biopsy. Associated with squamous cell CA in 4-6% of patients. 1% risk of malignant transformation. Annual f/u needed.
- Lichen planus
- Zoon’s (plasma cell): pinpoint red spots "cayenne pepper spots" (typical appearance) or bright red or brown shiny patches with red specks.
- May resemble erythroplasia of Queyrat. Dx by biopsy.
- Circinate: a manifestation of reactive arthritis (formerly Reiter’s syndrome).
- Premalignant conditions:
- Erythroplasia of Queyrat:
- Biopsy shows squamous cell carcinoma in situ.
- Bowenoid papulosis
- Bowen’s disease
- Sometimes referred to as squamous cell carcinoma in situ.
- Erythroplasia of Queyrat:
- Infection:
- Ddx: leukoplakia, lichen planus, psoriasis, seborrheic dermatitis, pemphigus, dermatitis artefacta, Bowen’s disease, Bowenoid papulosis.
- If not responsive to initial therapy, involve dermatology or urology consultants for consideration of biopsy (rule-out penile CA, pre-malignant lesion).
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