Balanitis

1 - ACKNOWLEDGEMENTS

Chapter written with the help of the EADV, the Fondation René Touraine and the Therapeutics in Dermatology

2 - OVERVIEW

Balanitis is an inflammation of the glans penis. When the foreskin is also involved, it is known as balanoposthitis. It is a common condition that can occur at any age, especially in uncircumcised males. Generally, it is not a serious condition and can be relieved with topical medication. Although uncommon, the main complication of balanitis (usually only in recurrent cases) is phimosis, or the inability to retract the foreskin of the glans penis.

3 - SYMPTOMS

Patients with balanitis may present with the following complaints:

• Swelling and redness of the glans penis or foreskin
• Tenderness of the glans penis
• Itching of the glans penis or foreskin
• Pain or difficulty with retraction of the foreskin
• Palpable lymph nodes

4 - CAUSES

Diabetes mellitus is the most common underlying condition associated with adult balanitis.

In addition, several infections cause balanitis, such as:

• Candida species (most commonly associated with diabetes) infection

• Streptococcal infection

• Sexually transmitted infections:

o Neisseria gonorrhoeae

o Chlamydia species

o Treponema pallidum (syphilis)

o Gardnerella vaginalis

o Trichomonal species

Other causes include:

• Poor personal hygiene or overwashing
• Use of chemical irritants (e.g., soap, shower gel)
• Skin disorders, such as eczema, psoriasis, lichen sclerosus, lichen planus or Zoon’s balanitis
• Oedematous conditions, such as congestive heart failure, cirrhosis, and nephrotic syndrome
• Obesity
• Drug allergies (e.g., antibiotics)
• Trauma

5 - TREATMENT

Most cases of balanitis are easily treated with good hygiene and topical therapy with creams or ointments. The treatment of choice depends on the cause.

• Topical or systemic antifungal for fungal or yeast infections
• Topical or systemic antibiotic for bacterial infections
• Topical steroid for inflammatory conditions

If left untreated, some complications may arise, such as phimosis, meatal stenosis and urinary retention.

Circumcision may be suggested for recurrent balanitis for which conservative therapy was ineffective or for phimosis.

6 - TIPS FOR MANAGING

Things you should do:

• Gentle retraction of the foreskin daily and soak in warm water to clean penis and foreskin
• Gently dry under the foreskin after urinating
• Control of diabetes and other chronic medical disorders in case of recurrent balanitis
• Weight reduction if obesity

Things you should not do:

• Do not use soap, shampoo or any other potential irritant

Ask for an appointment as soon as possible if:

• Persistence of symptoms despite treatment. Additional exams, such as a biopsy, may be needed to exclude other causes of balanitis.

Seek emergency care if:

• Fever
• Inability to retract the foreskin
• Inability to urinate
• Uncontrolled diabetes