Balanitis
Inflammation of the glans penis and the preputial mucosa of a circumcised penis (balanitis)
Specialty	Urology

Balanitis is inflammation of the glans penis.^[1] When the foreskin is also affected, the proper term is balanoposthitis.^[1] Balanitis on boys still in diapers must be distinguished from redness caused by ammoniacal dermatitis.^[2] The word balanitis is from the Greek βάλανος balanos, literally meaning 'acorn', used because of the similarity in shape to the glans penis.^[3]

Signs and symptoms

• Small red erosions on the glans (first sign)
• Redness of the foreskin
• Redness of the penis
• Other rashes on the head of the penis
• Foul smelling discharge
• Painful foreskin and penis

Complications

Recurrent bouts of balanitis may cause scarring of the preputial orifice; the reduced elasticity may lead to pathologic phimosis.^[4] Further complications may include:

• Stricture of urinary meatus
• Phimosis
• Paraphimosis

Cause

Inflammation has many possible causes, including irritation by environmental substances, certain medications, physical trauma, and infection such as bacterial, viral, or fungal.^[5][6] Some of these infections are sexually transmitted.

It is less common among people who are circumcised, as in many cases, a dysfunction of the foreskin is a causal or contributing factor.^[1] Both not enough cleaning and too much cleaning can cause problems.^[1]

Diagnosis

Diagnosis may include careful identification of the cause with the aid of a good patient history, swabs and cultures, and pathological examination of a biopsy.^[5]

Types

• Zoon's balanitis, also known as Balanitis Circumscripta Plasmacellularis or plasma cell balanitis (PCB), is an idiopathic, rare, benign penile dermatosis^[7] for which circumcision is often the preferred treatment.^[7][8][9] Zoon's balanitis has been successfully treated with the carbon dioxide laser; ^[10] and more recently, Albertini and colleagues report the avoidance of circumcision and successful treatment of Zoon's balanitis with an Er:YAG laser.^[11] Another study, by Retamar and colleagues, found that 40 percent of those treated with CO₂ laser relapsed.^[12]
• Circinate balanitis, also known as balanitis circinata, is a serpiginous annular dermatitis associated with reactive arthritis.
• Pseudoepitheliomatous keratotic and micaceous balanitis

Treatment

Initial treatment in adults often involves simply pulling back the foreskin and cleaning the penis.^[1] However, some topical antibiotic and fungal ointments may be used for treatment for mild cases. Depending upon severity, hydrocortisone and other steroidal creams may be used upon consultation.

Epidemiology

Balanitis "is a common condition affecting 11% of adult men seen in urology clinics and 3% of children" in the United States; globally, balanitis "may occur in up to 3% of uncircumcised males".^[13]

Other animals

In dogs, balanoposthitis is caused by a disruption in the integumentary system, such as a wound or intrusion of a foreign body. A dog with this condition behaves normally, with the exception of excessive licking at the prepuce, and a yellow green, pus-like discharge is usually present.

In sheep (rams/wethers), ulcerative enzootic balanoposthitis is caused by the Corynebacterium renale group (C. renale, C. pilosum & C. cystidis).

For the condition in bulls, caused by a virus see Bovine herpesvirus 1.

Balanoposthitis is believed to have contributed to the decline to near-extinction of Gilbert's potoroo.^[14]