Internal Medicine

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

222 Balanitis

specific therapy

■Specific therapy is possible only after appropriate diagnosis made

➣Candidal balanitis: Patient should be screened for possible dia-

betes. Careful cleansing and use of topical imidizole cream, or

BID application of nystatin-triamcinolone cream for 2 weeks

often successful.

➣Genital herpes: Acyclovir drug of choice. Oral acyclovir more

effective than topical therapy. Oral prophylaxis can be used long-

term. Alternative medication – famciclovir, valacyclovir.

➣Zoon’s balanitis (plasma cell balanitis): Circumcision or Mohs

micrographic surgery for excision is usual treatment.

➣Balanitis xerotica obliterans: Initial conservative management

with topical steroids and antibacterials. Consider biopsy, circum-

cision, partial resection, or Mohs micrographic surgery if topical

medication unsuccessful.

➣Bowen’s disease and erythroplasia of Queyrat: May be precursor

to squamous cell carcinoma. Diagnosis should be made based on

biopsy and histology. Treatment includes circumcision, partial

resection, or Mohs micrographic surgery.

➣Contact dermatitis: Attempt to remove causative irritant from

exposure. Common causes: iatrogenic application of various top-

icals, latex condoms, spermicides, nickel allergy, various cleans-

ing agents and disinfectants. Topical corticosteroids may provide

relief, combine with oral antihistamines for pruritus. Occasional

use of oral steroids required.

➣Reiter’s syndrome: Treatment involves appropriate use of antibi-

otic therapy – multidisciplinary approach to disease.

➣Psoriasis: Improvement of genital lesions seen with application

of topical steroids and emollients, dermatologic evaluation nec-

essary.

➣Condyloma: Treated most often topically using a variety of

agents. 5% imiquimod cream used primarily. Alternatively, 20%

podophyllin/benzoin or trichloroacetic acid. Goal of therapy to

remove lesion; total eradication of human papilloma virus most

often impossible. Electrocautery or laser therapy necessary for

large lesions not responding to topical agents; liquid nitrogen

also used as cryotherapy.

follow-up

■If initial conservative measures fail, biopsy is mandatory.