Balanitis

Overview
Balanitis is inflammation of the glans penis (from Greek: βάλανος balanos "acorn"). When the foreskin (or prepuce) is also affected, it is termed balanoposthitis.

Lack of aeration and irritation because of smegma and discharge surrounding the glans penis causes inflammation and edema.

Etiology and epidemiology
Inflammation has many possible causes, including irritation by environmental substances, physical trauma, and infection by a wide variety of pathogens, including bacteria, virus, or fungus &mdash; each of which require a particular treatment (Edwards, 1996).

Prevalence
Escala and Rickwood, in a 1989 examination of 100 cases of balanitis in childhood, concluded that the risk "in any individual, uncircumcised boy appears to be no greater than 4%." (Escala, 1989). Øster reported no balanitis in 9545 observations of uncircumcised Danish boys (Oster, 1968). Balanitis in boys still in nappies must be distinguished from the normal redness seen in boys caused by ammoniacal dermatitis (Simpson, 1998).

While any man can develop balanitis, the condition is most likely to occur in men who have a tight foreskin that is difficult to pull back, or who have poor hygiene. Diabetes can make balanitis more likely, especially if the blood sugar is poorly controlled.

Circumcision
Some studies indicate balanitis to be more common in uncircumcised boys (Fergusson, 1988; Herzog, 1986; Fakjian, 1990; Leber, 2005; Waskett, 2005), but Van Howe found balanitis only in circumcised boys (Van Howe, 1997). Van Howe's study has been criticised for the fact that few boys were uncircumcised (Waskett, 2005).

Genital washing
Many studies of balanitis do not examine the subjects' genital washing habits. However, O'Farrell et al. report that failure to wash the whole penis, including retraction of the foreskin in uncircumcised men, is more common among balanitis sufferers (O'Farrell, 2005). Birley et al., however, found that excessive genital washing with soap may be a strong contributing factor to balanitis (Birley, 1993).

Diagnosis
Diagnosis may include careful identification of the cause with the aid of a good patient history, swabs and cultures, and pathologic examination of a biopsy (Edwards, 1996).

Complications
Balanitis may cause oedema (Chow), resulting in phimosis, or inability to retract the foreskin from the glans penis. Adherence of the foreskin to the inflamed and edematous glans penis is the cause (Leber, 2005; Chow; Edwards, 1996).

Zoon's balanitis
Zoon's balanitis also known as Balanitis Circumscripta Plasmacellularis or plasma cell balanitis (PCB) is an idiopathic, rare, benign penile dermatosis (Keogh, 2005) for which circumcision is often the preferred treatment (Pellice, 1999; Buechner, 2002; Keogh, 2005). Zoon's balanitis has been successfully treated with the carbon dioxide laser (Baldwin, 1989) and more recently Albertini and colleagues report the avoidance of circumcision and successful treatment of Zoon's balanitis with an Er:YAG laser (Albertini, 2002). Another study, by Retamar and colleagues, found that 40 percent of those treated with CO2 laser relapsed (Retamar, 2003).

Circinate balanitis
Circinate balantitis (also known as balanitis circinata) is a serpiginous annular dermatitis associated with Reiter's syndrome.

Images of balanitis

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