Internal Medicine

0521779407-B01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:52

Balanitis 221

sclerosing lymphangiitis (perhaps related to trauma of inter-

course, transitory)

tests

■HLA-B27 for possible Reiter’s syndrome

■KOH and wet prep for possible Candidal infection

■dark field examination with antibody testing for syphilis

■viral culture and Tzanck prep for Herpes simplex

■culture for possible chancroid (Haemophilus ducreyi)

■biopsy makes diagnosis if conservative management fails or diagno-

sis uncertain

differential diagnosis

■Balanitis mostly seen in uncircumcised males; may be secondary

to poor hygiene, accumulated smegma beneath the foreskin. Other

causes include diabetes mellitus, infection (candida, gardnerella,

trichomonas, group B streptococcus, anaerobic microbials)), sys-

temic disease, or neoplasia. Erythematous areas adjacent to the

glans penis – candidal infection, Bowen’s disease, erythropla-

sia of Queyrat, plasma cell balanitis (Zoon’s balanitis), balani-

tis xerotica obliterans, squamous cell carcinoma in situ (Bowen’s

disease).

■Dry maculopapular exanthem suggests psoriasis, contact dermatitis,

possible Reiter’s syndrome.

■If ulcerated area adjacent to the glans penis, consider syphilis chan-

croid, granuloma inguinale, lymphogranuloma venereum.

■Punctate clusters of small vesicles suggest herpes simplex.

■Single large (usually >2 cm), bright-red, moist patch on the glans

penis or inner aspect of the foreskin suggests plasma cell balanitis

(Zoon’s balanitis).

■Definitive dx made with biopsy, serology, and/or culture

management

■Incorporates attention to proper diagnosis, as well as initial general

measures for treatment

■If infection suspected, appropriate topical antifungal or antibacterial

ointment or cream applied (bacitracin, imidizole)

■Warm soaks also helpful

■Appropriate cultures taken, follow-up appointment made to assess

initial success of general treatment measures