Materiały źródłowe

• #1 Balanitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK537143/

  Balanitis is inflammation of the glans penis. […] Balanitis and balanoposthitis are primarily infectious in origin, with Candida being the most common etiologic organism. […] The warm, moist environment under the uncircumcised penile foreskin, lack of aeration, sequestration of urine and urethral discharge or seepage, and the accumulation of irritating smegma promote the growth of organisms, most commonly Candida, that cause balanitis, leading to erythema, irritation, edema, inflammation, and discomfort of the glans penis. […] Fungal infections, particularly those caused by Candida albicans, are the most common identifiable infectious causes of balanitis and balanoposthitis. […] The risk of infection is also higher in men whose sexual partners have recurrent vaginal candidal infections.

• #2 Balanitis in adults – UpToDate

  https://www.uptodate.com/contents/balanitis-in-adults

  Balanitis is defined as inflammation of the glans penis. […] Most cases of balanitis are due to infection. However, in clinical practice, cases of balanitis can also be „nonspecific,” meaning that no associated condition or etiology is identified following diagnostic evaluation.

• #3 Balanitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/sites/books/NBK537143/

  Balanitis is inflammation of the glans penis. […] Balanitis and balanoposthitis are primarily infectious in origin, with Candida being the most common etiologic organism. […] The warm, moist environment under the uncircumcised penile foreskin, lack of aeration, sequestration of urine and urethral discharge or seepage, and the accumulation of irritating smegma promote the growth of organisms, most commonly Candida, that cause balanitis, leading to erythema, irritation, edema, inflammation, and discomfort of the glans penis. […] Fungal infections, particularly those caused by Candida albicans, are the most common identifiable infectious causes of balanitis and balanoposthitis. […] The risk of infection is also higher in men whose sexual partners have recurrent vaginal candidal infections.

• #4 Balanitis, Posthitis, and Balanoposthitis – Genitourinary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/genitourinary-disorders/penile-and-scrotal-disorders/balanitis-posthitis-and-balanoposthitis

  Balanitis is inflammation of the glans penis, posthitis is inflammation of the prepuce, and balanoposthitis is inflammation of both. […] Inflammation of the head of the penis most commonly occurs in people with poor hygiene. It has both infectious and noninfectious causes. […] Balanitis usually leads to posthitis except in circumcised patients. […] Phimosis interferes with adequate hygiene. Subpreputial secretions may become infected with anaerobic bacteria, resulting in inflammation. […] Chronic balanoposthitis increases the risk of Balanitis xerotica obliterans, Phimosis, Paraphimosis, and Cancer. […] Hygiene measures should be instituted and specific causes treated. Subpreputial irrigation to remove secretions and detritus may be necessary. If phimosis persists after inflammation has resolved, circumcision should be considered. Circumcision reduces the risk of balanitis and appears to reduce the risk of HIV infection by about 50 to 60% in men who have sex with HIV-positive females.

• #5 Balanitis: Causes, symptoms, and treatments

  https://www.medicalnewstoday.com/articles/184715

  Balanitis is an inflammation of the head of the penis or clitoris due to infection or another cause. It can be uncomfortable and sometimes painful, but is usually not serious. Symptoms include a tight foreskin and pain while urinating. […] The most common cause of balanoposthitis is the poor hygiene of an uncircumcised penis. Poor hygiene can lead to a buildup of dead skin, bacteria, sweat, and other debris that can cause inflammation. […] Infection with Candida albicans is another common cause. Candida is the fungus that causes thrush. […] Bacteria: These can multiply rapidly in the moist and warm conditions under the foreskin. […] Sexually transmitted infections (STIs): Examples include herpes simplex virus, chlamydia, and syphilis. […] Skin conditions: In some cases, skin conditions, such as lichen planus, eczema, or psoriasis, can cause balanitis to occur.

• #6 Balanoposthitis | Tidsskrift for Den norske legeforening

  https://tidsskriftet.no/en/2023/11/clinical-review/balanoposthitis

  Balanoposthitis is a descriptive term that encompasses various disparate conditions with inflammation of the glans penis and/or prepuce. The word originates from the Greek balanos, meaning acorn. Balanoposthitis has many aetiologies but is typically due to intertrigo (inflammation in skin or mucosal folds, often with bacterial or fungal overgrowth). It is therefore rare in circumcised men. […] The sub-preputial environment is unique in terms of moisture, pH, cellular debris, irritants (such as urine and secretions) and microbiome. Within the prepuce are sebaceous glands that produce smegma, and within the urethra are Littr’s glands, which produce mucus. Together these help to keep the penile head and the sub-preputial space moist. Common skin bacteria such as staphylococci and corynebacteria are found here, but the occlusive conditions also allow for the growth of other aerobic and anaerobic bacteria. A prepuce that covers half or more of the penile head (redundant prepuce), as well as a tight prepuce that is difficult to retract behind the penile head, have been shown to increase the risk of balanoposthitis.

• #7 Balanitis: What Causes It and How To Treat It

  https://patient.info/mens-health/penis-problems/balanitis

  Balanitis is when the head of the penis (the glans) becomes inflamed. […] There are many different causes of balanitis. These include infectious and non-infectious causes. […] Poor hygiene around this area, combined with a tight foreskin, can lead to irritation by smegma. Smegma is a cheesy-like substance which forms under the foreskin if the end of the penis (the glans) under the foreskin is not cleaned. This is the most common cause of balanitis. […] Various germs (bacteria) that live on the skin in small numbers may multiply and cause infection. A common cause of balanitis is a yeast infection caused by a fungus called candida. […] Certain skin conditions may cause a balanitis, or be mistaken for a balanitis – for example, psoriasis and some uncommon skin conditions can affect the penis.

• #8 Balanitis and related inflammatory conditions affecting the penis | Publisso

  https://series.publisso.de/en/publisso_gold/publishing/books/overview/52/22

  In men aged 16-95 years (mean age 47 years), a 3-year prospective review at a multi-specialty penile dermatology clinic in Edinburgh, UK, diagnosed non-specific balanitis in 22% of patients. […] A meta-analysis of relevant studies found that the prevalence of balanitis was 68% lower in circumcised vs. uncircumcised males (odds ratio = 0.32; 95% CI 0.200.52). […] Circumcision would appear desirable to reduce the occurrence of balanitis.

• #9 Balanitis and related inflammatory conditions affecting the penis | Publisso

  https://books.publisso.de/index.php/en/publisso_gold/publishing/books/overview/52/22

  Circumcision provides substantial protection against balanitis. […] A meta-analysis of relevant studies found that the prevalence of balanitis was 68% lower in circumcised vs. uncircumcised males (odds ratio = 0.32; 95% CI 0.200.52). […] Topical therapy using a cream or ointment is effective in treatment of balanitis, but recurrence is frequent especially in patients with risk factors such as phimosis or diabetes. […] Circumcision would appear desirable to reduce the occurrence of balanitis.

• #10 Infectious balanitis – wikidoc

  https://www.wikidoc.org/index.php/Infectious_balanitis

  Balanitis is inflammation of glans penis. […] Studies have shown that balanitis commonly occurs around 10% of the patient population visiting the STD clinics, with infectious etiology responsible for around 50% of the cases. […] Microorganisms causing balanitis could be part of the normal flora or sexually transmitted or autoinoculation or transmitted via direct contact with infectious lesions. […] Pathophysiology of infectious balanitis varies from pathogen to pathogen. […] Adherence, contact-independent factors, hemolysis and acquisition of host macromolecules have been shown to play a role in the pathogenesis of this infection. […] Treponema pallidum uses fibronectin molecules to attach to the endothelial surface of the vessels in organs resulting in inflammation and obliteration of the small blood vessels causing vasculitis (endarteritis obliterans). […] Prognosis is usually good with treatment.

• #11 Balanitis: Practice Essentials, Etiology

  https://emedicine.medscape.com/article/777026-overview

  Balanitis is inflammation of the glans penis and is a common condition that affects an estimated 3-11% of males. […] Morbidity is associated with the complications of phimosis. […] Predisposing factors include poor hygiene and overwashing, use of over-the-counter medications, and nonretraction of the foreskin. […] Lack of aeration and irritation because of smegma and discharge surrounding the glans penis causes inflammation and edema. […] Diabetes is the most common underlying condition associated with adult balanitis. […] Pathogens that can cause balanitis include the following: Candidal species (most commonly associated with diabetes), Group B and group A beta-hemolytic streptococci, Neisseria gonorrhoeae, Chlamydia species, Anaerobes (eg, Bacteroides), Human papillomavirus, Gardnerella vaginalis, Treponema pallidum (syphilis), Trichomonal species, Borrelia vincentii and Borrelia burgdorferi.

• #12 Balanitis: Infection of the Penis Tip and Foreskin

  https://www.webmd.com/men/penis-disorder-balanitis

  Balanitis usually happens because of a bacterial, fungal, viral, or parasitic infection. […] Most cases of balanitis develop in people who have a foreskin and don’t keep it clean and dry. That’s because the types of organisms that cause balanitis, such as fungi, thrive in that moist and warm environment. Fungal infections cause most cases of balanitis. […] Poorly managed diabetes and some type 2 diabetes medications, such as dapagliflozin (Farxiga). The drug works by flushing sugar out of your body in your urine. Sugar creates a breeding place for yeast to grow. […] Without treatment, balanitis can cause complications such as chronic inflammation that can become cancerous, though this is rare.

• #13 Balanitis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/18119

  Many diseases, infections, and disorders affect the male genitalia, including inflammatory lesions, infectious processes, preneoplastic syndromes, and malignant conditions. […] The most common cause of balanitis is poor or inadequate personal hygiene in uncircumcised males, leading to candidal infection. […] The warm, moist environment under the uncircumcised penile foreskin, lack of aeration, sequestration of urine and urethral discharge or seepage, and the accumulation of irritating smegma promote the growth of organisms, most commonly Candida, that cause balanitis, leading to erythema, irritation, edema, inflammation, and discomfort of the glans penis. […] Fungal infections, particularly those caused by Candida albicans, are the most common identifiable infectious causes of balanitis and balanoposthitis.

• #14 Balanitis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/18119

  C albicans is normally present on the skin of the glans and can be considered part of the normal flora. However, colonization can progress to an outright infection under certain conditions, particularly in individuals with underlying medical conditions; poor hygiene; uncircumcised men, especially those with phimosis; or changes in baseline pH. […] The risk of infection is also higher in men whose sexual partners have recurrent vaginal candidal infections. […] Diabetes is the most commonly identified underlying contributing disorder. […] Data from meta-analyses show that circumcised males have a substantially lower prevalence of balanitis (68%) compared to uncircumcised males and that balanitis is associated with a 3.8-fold increase in the risk of penile cancer. […] Although yeast infection is the most commonly identified cause of balanitis, numerous other potential causes must be considered, including both infectious and noninfectious agents.

• #15 Balanitis and related inflammatory conditions affecting the penis | Publisso

  https://books.publisso.de/index.php/en/publisso_gold/publishing/books/overview/52/22

  Inflammatory skin conditions of the glans (balanitis) and foreskin (posthitis) are common in uncircumcised males of all ages. […] Yeasts and other microorganisms accumulate under the foreskin and contribute to inflammation of the surrounding penile tissue. […] Inflammatory lesions of penile skin are common. They include balanitis (inflammation of the glans penis), posthitis (inflammation of the foreskin) and balanoposthitis (inflammation of both the glans and foreskin). […] These conditions are caused by fungal infections, most commonly the yeast Candida albicans, potentially associated with polymicrobial flora. […] It has been found recently that Candida albicans releases a peptide toxin, candidalysin, which is a critical molecular determinant of the epithelial damage that ensues when the filamentous structures of yeast, termed hyphae, make contact with and breach the epidermal barrier of the host cell.

• #16 Balanoposthitis | Tidsskrift for Den norske legeforening

  https://tidsskriftet.no/en/2023/11/clinical-review/balanoposthitis

  Eczema is the most common cause of balanoposthitis, and includes atopic, seborrheic, irritant and allergic contact dermatitis. Many of these constitute different forms of intertrigo. Atopic balanoposthitis often presents as erythematous, poorly demarcated and sometimes erosive mucosal changes. Irritant contact dermatitis, typically triggered by frequent use of soap, is particularly common and is often seen in atopic individuals. Seborrheic dermatitis is caused by hypersensitivity to the yeast Malassezia furfur, and its clinical presentation overlaps with other forms of eczema. […] Candidal balanoposthitis presents as somewhat non-specific, erythematous mucosal changes with soreness and itching. Erythematous papules, punctate erosions and/or whitish scaling increase the suspicion of fungal infection. Risk factors include diabetes mellitus, immunodeficiency, immunosuppressive treatment, antibiotic treatment, older age and excessive or poor hygiene. Candidal balanoposthitis is likely overdiagnosed, as less than 20 % of all balanoposthitis cases are due to candida infection.

• #17 Balanitis and related inflammatory conditions affecting the penis | Publisso

  https://books.publisso.de/index.php/en/publisso_gold/publishing/books/overview/52/22

  Microorganisms under the foreskin have the potential to cause penile inflammatory conditions. The microorganisms include various bacterial species and yeasts. […] Mycotic infections are a common cause of balanitis. Candida species are the most prevalent, being found in approximately one-third of cases. […] Bacteria by themselves are the second most common cause of infectious balanitis, Streptococcus spp. being seen most often. […] Lack of circumcision is a predisposing factor, especially when the foreskin is partly or completely non-retractable. […] Balanitis is especially common in uncircumcised boys with phimosis compared with those without phimosis: 25% vs. 6%, respectively, for ages less than 5 years and 24% vs. 12% for males older than 5 years. […] Apart from exposure to certain medications, allergens and chemical irritants, lack of circumcision has been consistently associated with balanitis in men.

• #18 Balanoposthitis | Tidsskrift for Den norske legeforening

  https://tidsskriftet.no/en/2023/11/clinical-review/balanoposthitis

  Bacterial balanoposthitis can be caused by both aerobic and anaerobic bacteria. Aerobic balanoposthitis is a common condition and is often caused by staphylococci and/or streptococci. Common findings include variable inflammatory changes, including erythema, mild oedema and occasional suppuration. In anaerobic balanoposthitis, severe inflammation can be found with mucosal oedema, foul-smelling, superficial and weeping erosions, and in some cases inguinal lymphadenopathy. Anaerobic balanoposthitis can be caused by spirochetes, fusiform bacteria and Gram-negative rods, including anaerobic bacteria associated with bacterial vaginosis. […] Lichen sclerosus is an inflammatory skin disease that causes scarring to the penis. The aetiology is unknown, but chronic irritation triggered by urine may be one of the causes. Initial presentation can include erythema, fissures and haemorrhagic mucosal changes. Patients often report itching. Chronic inflammation can lead to sclerotic mucosal changes, adhesions, phimosis and meatal stenosis. It also increases the risk of malignant transformation to cancer by 012.5 % compared to healthy individuals.

• #19 Balanoposthitis: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1124734-overview

  Balanoposthitis may also occur as a manifestation of syphilis. […] Although, in general, fungal infections of the penis are rare, it has been suggested that candidal balanitis/balanoposthitis is the most common mycotic infection of the penis. […] In one series, Candida species accounted for 30% of the causative organisms, with beta-hemolytic streptococci accounting for 13%. […] In another study, Candida species were identified as the causative pathogen in 50% of patients and Streptococcus species in 25%; no growth was noted in 13% (12% were not tested). […] Rare causes include Streptococcus pyogenes, Prevotella melaninogenica, Cordylobia anthropophaga, Pasteurella bettyae, Providencia stuartii, and Pseudomonas aeruginosa, the last two in individuals who are immunocompromised. […] Reports of an association between human papillomavirus (HPV) infection and longstanding balanoposthitis have been published, but this association may be a noncausal one. […] Associations with ulcerative colitis and Crohn disease have also been noted. […] Granulomatous balanoposthitis after intravesical bacille Calmette-Gurin (BCG) vaccine instillation has been described.

• #20 Erosive balanitis caused by Staphylococcus haemolyticus in a healthy, circumcised adult male. | Microbiology Society

  https://www.microbiologyresearch.org/content/journal/acmi/10.1099/acmi.0.000582.v2

  Balanitis is an inflammation of the glans penis. […] Staphylococcus haemolyticus is a part of skin microflora and one of the main species of coagulase-negative staphylococci. […] S. haemolyticus causes various infections of the male urogenital tract such as urinary tract infections, chronic prostatitis and epididymo-orchitis, but it has not been associated with balanitis. […] He had no urinary discomfort or inguinal lymphadenopathy. Abundant growth of Staphylococcus haemolyticus was obtained in the culture in standard bacterial media of the sample taken from the genital lesion. […] Conclusion we present a non-diabetic, circumcised male patient with severe, erosive, and painful balanitis due to S. haemolyticus.

• #21 Balanoposthitis: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1124734-overview

  Although multiple organisms have been incriminated in the pathogenesis of balanoposthitis, most patients are treated empirically, without confirmation of a specific causative organism. […] The multicausal origin of balanoposthitis was emphasized in a study that identified infectious, mechanical/traumatic, or contact dermatitides in 34 of 51 (67%) patients with mild balanoposthitis; in the remaining 17, no specific cause could be established even after clinical examination and microbiologic and serologic tests had been performed. […] Candidal infection appears to be the most common cause of balanoposthitis. […] In older men, other etiologic factors are often present, including intertrigo, irritant dermatitides, or other fungal infections. […] Organisms that have been identified include Bacteroides, Gardnerella, and Candida species, as well as beta-hemolytic streptococci.

• #22 Syphilitic Balanitis of Follmann: Three Case Reports | HTML | Acta Dermato-Venereologica

  https://www.medicaljournals.se/acta/content/html/10.2340/00015555-0983

  Treponema pallidum has been implicated as a possible cause of balanitis since the reports of Follmann (1). […] The pathogenesis of syphilitic balanitis of Follmann was clarified by the clinicopathological study of Lejman Starzycki (3) According to the results of this study, the active penetration of T. pallidum through the epidermis has a haematogenous origin. […] In conclusion, balanitis can be the sole clinical expression of primary syphilis. Thus, clinicians should suspect a treponemal infection in all cases of balanoposthitis, particularly when the glans penis is indurated and lymphadenopathy is present. Syphilitic serology should be performed systematically in cases of balanoposthitis, as it is the only means of confirming the diagnosis.

• #23 Balanitis and balanoposthitis: a review

  https://www.cirp.org/library/disease/balanitis/edwards1/

  The presence of anaerobes on the glans penis, particularly in the uncircumcised male has been associated with non specific urethritis (NSU) and balanitis. […] The features of anaerobic balanitis are superficial erosions, foul smelling subpreputial discharge, preputial oedema an inguinal adenitis. […] A severe erosive and gangrenous form of anaerobic balanitis has been recognised for many years with the presence of anaerobes and fusobacterium spp. […] The symptoms of pure Gardnerella vaginalis balanitis are milder than those in anaerobic infection with irritation of the prepuce and glans penis, macular erythema and a fishy sub-preputial discharge. […] The association between balanitis xerotica obliterans and lichen sclerosus et atrophicus was made by Laymon and Freeman who described five patients with skin lesions as well as genital involvement.

• #24 Balanitis: Causes, Symptoms, Management, and More — DermNet

  https://dermnetnz.org/topics/balanitis

  Balanitis can be best categorised as infectious versus non-infectious aetiologies. […] Infectious aetiologies include, but are not limited to: Fungal infection (most common overall cause) […] Non-infectious aetiologies include, but are not limited to: Inflammatory conditions […] Specific measures for more severe inflammatory causes of balanitis (such as Zoons balanitis, genital lichen planus, BXO) include stronger topical corticosteroids and/or topical calcineurin inhibitors. […] Most individuals with balanitis recover without complications with appropriate treatment and genital hygiene measures.

• #25 Balanitis

  https://www.pcds.org.uk/clinical-guidance/balanitis

  Balanitis is inflammation of the glans penis (head of the penis). It is a common condition that predominantly affects uncircumcised males, and as such the inflammation frequently involves the foreskin. […] Uncircumcised men with poor personal hygiene are most affected by balanitis. […] Mechanical or chemical irritation in boys, repeatedly playing with their foreskin. […] Chemical irritation from urine, soaps and other irritant substances. […] Infection: Candida, which is more common in people with diabetes or who have recently taken antibiotics. […] Bacterial infection eg streptococci. […] Anaerobic infection. […] Sexually transmitted infections. […] Inflammatory dermatoses: Eczema can cause significant inflammation of the glans penis or any part of the genital skin. […] Psoriasis tends to cause small scaly lesions that can affect any part of the genitalia, as opposed to a true balanitis.

• #26 A Pustular Psoriasis Limited to the Glans Misdiagnosed as Balanitis or Reiter’s Syndrome

  https://clinmedjournals.org/articles/ijdrt/journal-of-dermatology-research-and-therapy-ijdrt-3-050.php?jid=ijdrt

  Genital pustular psoriasis is a rare condition characterized by well-demarcated, clear erythematous, absence of the typical scaling which is apparent on non-genital psoriasis. […] The cause of pustular psoriasis is complicated and not fully understood. Infection, drugs, sunlight, and pregnancy have been reported to be associated with generalized pustular psoriasis. Psoriasis is a chronic inflammatory disease, signaling pathways of NF-κB, IFR-γ, IL-23, IL-17 and TNF-α may be involved in. […] Based on characteristics of the skin lesions on the glans and histopathological examination, our patient was diagnosed with localized pustular psoriasis occurring atypically only on the glans penis.

• #27 Noninfectious Penile Lesions | AAFP

  https://www.aafp.org/pubs/afp/issues/2010/0115/p167.html

  Lichen sclerosus, also known as balanitis xerotica obliterans, occurs in males of all ages. The average age at diagnosis is 42 years. The estimated prevalence may be as high as one in 300 males. Lichen sclerosus is associated with squamous cell carcinoma in 4 to 6 percent of patients. Many physicians consider genital lichen sclerosus in males to be a precancerous condition that is similar to its counterpart in females. […] Lichen sclerosus appears as a hypopigmented lesion with a skin texture similar to crinkled paper or cellophane. It primarily affects the glans penis and prepuce. Bullae, erosions, or atrophy may be prominent. Patients typically present with phimosis, painful erections, obstructive voiding, itching, pain, and bleeding. Because the progression of the lesions may lead to obstruction, urinary retention may be the initial complaint. Lichen sclerosus should be differentiated from carcinoma in situ, leukoplakia, and scleroderma.

• #28 Balanitis: Etiology, Diagnosis and Therapy

  http://www.urology-textbook.com/balanitis.html

  Balanitis in children usually arises from an infection of the smegma because of phimosis or adhesions of the prepuce. […] Balanitis caused by infection: Candida, bacteria, viruses (herpes). Oral therapy of diabetes mellitus with SGLT-2 inhibitors (e.g., dapagliflozin) leads to chronic glucosuria, which significantly increases the risk of external genital infections. […] Balanitis xerotica obliterans (BXO) is the manifestation of lichen sclerosus on the glans penis. BXO presents with porcelain white spots or papules on the glans with a sharp border. The atrophy leads to phimosis, meatal stenosis, urethral stricture of the fossa navicularis, or, in females, to kraurosis vulvae. Lichen sclerosus is sporadically associated with squamous cell carcinoma. […] In doubt of the etiology or resistance to standard care, a microbiological culture and/or biopsy should be obtained.

• #29

  https://journals.lww.com/ijd/fulltext/2024/01000/zoon_s_balanitis___update_of_clinical_spectrum_and.10.aspx

  Zoons balanitis or balanitis plasmacellularis circumscripta is a chronic inflammatory disorder of the genital mucosa that can affect both males and females (Zoons vulvitis). […] Pathogenesis still remains to be established, although it is most commonly thought to be due to chronic irritation of genital mucosa owing to various factors like trauma, friction, heat, poor hygiene, etc. […] Histopathology is typical, showing plasma cell predominant inflammatory infiltrate in the dermis with variable number of lymphocytes and eosinophils. […] Few factors that are thought to provoke this disease are irritation, trauma, friction, heat, dribbling of urine and poor hygiene. […] Chronic infection with mycobacterium smegmatis and human papilloma virus is also implicated. […] Immediate hypersensitivity response to an unknown exogenous antigen leading to the production of IgE antibodies has also been implicated in its pathogenesis by Nishimura et al.

• #30 Chronic balanitis: When should we be concerned?

  https://www1.racgp.org.au/ajgp/2020/december/chronic-balanitis

  The most likely diagnosis is Zoons balanitis, a benign disease occurring almost exclusively in uncircumcised older men and accounting for up to 10% of all reported balanitis cases. Its aetiology is thought to be associated with inadequate bathing and/or contextual dysfunction of the prepuce, causing either urine retention, smegma build-up, friction or heat, which ultimately results in chronic irritation of the mucosa. […] Common histological findings include epidermal thickening or atrophy with possible erosions and spongiosis, and infiltration of the dermal layer with predominantly plasma cells and hemosiderin deposits. […] Initial management of patients with balanitis/balanoposthitis without concerns for neoplasia includes general hygiene measures, topical antifungal medication and/or corticosteroids with regular follow-up.

• #31 Zoon Balanitis Revisited: Report of Balanitis Circumscripta Plasmacellularis Resolving With Topical Mupirocin Ointment Monotherapy – JDDonline – Journal of Drugs in Dermatology

  https://jddonline.com/articles/zoon-balanitis-revisited-report-of-balanitis-circumscripta-plasmacellularis-resolving-with-topical-m-S1545961617P0285X/?_page=3

  Several treatment options, of ranging success, are available for patients with Zoon balanitis. […] His complete response to mupirocin monotherapy could suggest that, in some patients with Zoon balanitis, there may be a bacterial component involved in the pathogenesis of the disease. […] Zoon balanitis is a benign inflammatory condition of the penis with an unknown pathogenesis. […] Our findings not only prompt us to recommend future investigations regarding the efficacy of mupirocin monotherapy in a larger number of Zoon balanitis patients, but also to speculate that in some individuals a bacterial etiology may contribute to the pathogenesis of balanitis circumscripta plasmacellularis.

• #32

  https://link.springer.com/article/10.1007/s13555-017-0178-1

  Zoons balanitis, also referred to as balanitis circumscripta plasmacellularis (BCP), is an idiopathic, benign inflammatory condition of the glans penis and foreskin most often seen in elderly uncircumcised men. […] The pathogenesis of BCP remains to be established. Successful management with mupirocin, an antibiotic that blocks protein synthesis, raises the possibility that BCP may directly or indirectly be implicated with bacterial infection or super-antigen. Other postulated mechanisms of pathogenesis include: chronic irritant contact dermatitis due to chronic Mycobacterium smegmatis infection, foreskin inflammation, friction, heat, hypospadias, IgE-antibody-mediated hypersensitivity response, lack of hygiene, nonspecific polyclonal stimulation of B cells, penile trauma, pre-malignancy, and T cell-mediated damage.

• #33 Balanitis Xerotica Obliterans – from Etiology to Prognosis

  https://symbiosisonlinepublishing.com/urology-nephrology/urology-nephrology38.php

  Balanitis xerotica obliterans is a disease of undetermined origin, despite strong evidence of autoimmune etiology and association with autoimmune diseases such as hyperthyroidism, vitiligo, hypothyroidism and DM I. […] The strong association of the pathology with the penis allied to a constant underdiagnosis can contribute to the increased prevalence of complications such as phimosis, meatal stenosis and, less frequently, renal failure, which translates into more expenses with treatment and palliation of the consequences of BXO. […] Early detection is a key element in the prevention of these complications, and the therapeutic strategy of choice – circumcision – is operationally simple, entails few costs to the National Health System and is extremely effective as a therapeutic and preventive measure.

• #34 Balanitis Xerotica Obliterans – from Etiology to Prognosis

  https://symbiosisonlinepublishing.com/urology-nephrology/urology-nephrology38.php

  The high production of pro-inflammatory cytokines such as IFN-Gamma, CXCR3, CXCL9, CXCL10, CXCL11, CCR5, CCL4 and CCL5 is specific for an IFN-gamma-mediated Th1 immune response. […] In a study developed by Gross, et al, it was found that T lymphocytes involved in SL had T-cell restricted intracellular antigen (TIA-H) and cytotoxic granzyme B (GrB) – related to cytotoxic activity in their granules. […] Micro-RNA-155, involved in the regulation of the immune response, was also over-regulated. […] Local Factors: Factors such as meatal stenosis that causes high pressure when bladder emptying causes irritation of Littre glands, leading to inflammation, fibrosis and LS development.

• #35 Balanitis Xerotica Obliterans – from Etiology to Prognosis

  https://symbiosisonlinepublishing.com/urology-nephrology/urology-nephrology38.php

  The first case of BXO was described by Stuhmer in 1928, since there have been advances in understanding the pathogenesis of the disease, and advances in electron microscopy techniques, which allowed the establishment of the autoimmune nature of this disease. […] Immune nature turns out to be a crucial point in understanding the pathogenesis of this disease. […] According to available literature, only MYOPODIN and CABLES appear to be relevant for the development of BXO and SCC. […] However, the expression patterns of CABLES1 and MYOPODIN require further studies to assess their importance in pathogenesis. […] Further studies are needed to understand the implication of this gene in the pathogenesis of BXO. […] There is a strong association in LS patients with HLA-DQ7, HLA-D08, HLA-DQ9 and HLA-DRABII2 – suggesting a genetic background.

• #36 Balanitis: Causes, symptoms, and treatments

  https://www.medicalnewstoday.com/articles/184715

  Irritants: Several chemicals, detergents, and perfumes can act as irritants that lead to balanitis. […] The most common risk factor for balanitis is poor hygiene related to an uncircumcised penis. […] In addition, there may be an association between balanitis and penile cancer. Balantis may be a risk factor for penile cancer. […] An older 2017 meta-analysis suggests balanitis carries a 3.8-fold increase in penile cancer risk. However, early circumcision appears to decrease the risk of penile cancer. […] The goals of treatment typically involve reducing sexual or urinary dysfunction and reducing the risk of developing cancer in the area. […] Practicing good hygiene, including cleaning the penis daily and keeping the area under the foreskin clean and dry, is the most important step a person can take to prevent balanitis.

• #37 Balanitis and balanoposthitis: a review

  https://www.cirp.org/library/disease/balanitis/edwards1/

  Balanitis is defined as inflammation of the glans penis, which often involves the prepuce (balanoposthitis). It is a common condition affecting 11% of male genitourinary clinic attendees in one study and it can be a recurrent or persistent condition. There is a wide variety of causes and predisposing factors; balanitis is more common among uncircumcised men possibly as a result of poorer hygiene and aeration or because of irritation by smegma. […] Underlying medical conditions can also predispose to balanitis, which may be more severe. It has been reported as a source of fever and bacteraemia in neutropenic men, and candidal balanitis may be especially severe in patients with diabetes mellitus. […] Inflammation of the glans and prepuce may also provide a route for the acquisition of the human immunodeficiency virus (HIV) infection.

• #38 What Is Balanitis? Causes, Symptoms & Effective Treatments | Aashlok Hospital

  https://aashlokhospital.com/blog/balanitis-causes-symptoms-treatments/

  Manifestations of balanitis of the glans penis are inflammation, redness, swelling, and pain. […] Moreover, research has indicated that underlying medical conditions, including poorly controlled diabetes, may exacerbate the condition because of the increased susceptibility to infections and impaired immune responses. […] More importantly, a 2019 systematic review emphasized the involvement of dermatologic conditions such as eczema and psoriasis in balanitis pathogenesis, especially in predisposed men. […] Most primary causes of balanitis are medical conditions, particularly diabetes. High blood sugar creates a very conducive environment for infections, especially fungal infections. Also, individuals with weak immune systems have a higher risk of getting balanitis.

• #39 Balanitis and balanoposthitis | Holistic Andrology

  https://urologistandandrologistlondon.com/our-expertise/genital-health/balanitis-and-balanoposthitis/

  Balanitis is caused by inflammation or infection that occurs at the level of the glans, often due to poor intimate hygiene or because it is not possible to find out by sliding the foreskin towards the base of the shaft of the penis (due to phimosis, a very common eventuality in children and up to adolescence). […] Other possible causes include infections with fungi (Candida) or bacteria that live on the skin (it can occur, for example, in case of diabetes, taking antibiotics or simply in case of poor hygiene), sexually transmitted infections, such as genital herpes, gonorrhea and syphilis, skin irritation caused by aggressive detergents (contact dermatitis), benign skin diseases, such as psoriasis, atopic eczema, lichen, some types of skin cancer (are very rare). […] Diabetes is a known risk factor for all kinds of infections, especially if you can not control your blood sugar well; in case of too high values (hyperglycemia), there is an increase in the sugars present in the urine which, coming into contact with the glans and foreskin, tends to favour the proliferation of yeasts and bacteria.

• #40 Balanitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/sites/books/NBK537143/

  Balanitis is most common in uncircumcised males due to poor hygiene and the accumulation of smegma beneath the foreskin. […] Typical symptoms of balanitis include pain, redness, and a foul-smelling discharge from under the foreskin. […] The condition has a more fulminant clinical presentation in diabetic and immunocompromised patients. […] Localized edema may develop if balanitis is allowed to progress without treatment. […] The combination of inflammation and edema can cause the foreskin to adhere to the glans and may also progress to penile cellulitis and adhesions.

• #41 Balanitis: Causes, Symptoms, and Diagnosis

  https://www.healthline.com/health/balanitis

  Other treatments can be used to help relieve the inflammation and treat the underlying cause. This might include: Antifungal creams, Anti-itch creams, Steroid creams, Antibiotics, Diabetes treatment, Circumcision. […] Left untreated, balanitis can cause chronic inflammation and lead to complications, such as: Lichen sclerosus, Scar tissue, Ulcerative lesions, Increased risk of cancer. […] Prompt treatment of balanitis and any underlying causes can significantly reduce the risk of complications and improve your outlook.

• #42 Balanitis Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/balanitis

  Balanitis is swelling of the foreskin and head of the penis. […] Balanitis is most often caused by poor hygiene in uncircumcised men. Other possible causes include: Diseases, such as reactive arthritis and lichen sclerosus atrophicus, Infection, Harsh soaps, Not rinsing soap off properly while bathing, Uncontrolled diabetes. […] Treatment depends on the cause of the balanitis. Antibiotic pills or creams are used to treat balanitis that is caused by bacteria. Steroid creams may help balanitis that occurs with skin diseases. Anti-fungal cream will be prescribed if it is due to a fungus. […] Long-term swelling or infection can: Scar and narrow the opening of the penis (meatal stricture), Make it difficult and painful to retract the foreskin to expose the tip of the penis (a condition called phimosis), Make it difficult to move the foreskin over the head of the penis (a condition called paraphimosis), Affect the blood supply to the tip of the penis, Increase the risk of penile cancer. […] Good hygiene can prevent most cases of balanitis. When you bathe, pull back the foreskin to clean and dry the area under it.

• #43 Balanitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK537143/

  Data from meta-analyses show that circumcised males have a substantially lower prevalence of balanitis compared to uncircumcised males and that balanitis is associated with a 3.8-fold increase in the risk of penile cancer. […] These data suggest that chronic inflammation or infection (balanitis) is an etiological factor for penile carcinoma. […] Poor hygiene, a tight foreskin, and the accumulation of smegma, which serves as a nidus for bacterial and fungal overgrowth, can lead to localized irritation, infection, and inflammation of the glans and the foreskin. […] Fungal infections are typically responsible, most commonly involving C albicans. […] In some cases, dermatologic conditions, such as psoriasis, lichen planus, or lichen sclerosus; allergic reactions; or, less likely, premalignant conditions may be responsible.

• #44 Balanitis and balanoposthitis: a review

  https://www.cirp.org/library/disease/balanitis/edwards1/

  The main symptoms are pain, irritation, disturbance of sexual function, or urinary symptoms (including obstruction). […] The clinical appearance is of white plaques on the glans, often with involvement of the prepuce which becomes thickened and non-retractile. […] The course is chronic and relapsing, and although it may sometimes arrest, the areas of atrophy do not regress. […] Development of squamous cell carcinoma has been reported in patients with balanitis xerotica obliterans, both in areas of active and quiescent disease, but malignant change appears to be less common than in lichen sclerosus et atrophicus in the female. […] Many balantides prove difficult to diagnose and any condition which persists warrants further investigation. Penile biopsy is easy to perform and is useful in these cases.

• #45

  https://journals.lww.com/ijd/fulltext/2024/01000/zoon_s_balanitis___update_of_clinical_spectrum_and.10.aspx

  Due to the presence of marked haemorrhage along with lichenoid infiltrate, it has also been linked to lichen aureus. […] Hyman and Leider speculated that due to the presence of plasmacytic infiltration in such areas, it could be an expression of occult myeloma. […] Since the infiltrate is polyclonal in nature, the above said theory has been negated. […] It is generally considered to be a benign condition, and its association with malignancies has been rarely reported (only three case reports so far). […] A possible association between Zoons balanitis and penile cancer could be that of chronic inflammation. […] Histopathology remains the gold standard for diagnosis despite emerging diagnostic modalities like reflectance confocal microscopy (RCM) and dermoscopy. […] Because of variable histological features in these cases, they concluded that Zoons balanitis should be considered a non-specific inflammatory disorder, which can mask features of the underlying disease rather than a distinct entity. […] It is important to teach the patients about adequate hygiene measures since trauma, friction, poor hygiene and smegma have been postulated as the possible triggers of this disease. […] However, Erbium-Yag Laser is an upcoming promising treatment that can lead to long-term remission.

• #46 Balanitis

  https://www.pcds.org.uk/clinical-guidance/balanitis

  Lichen sclerosus is one of a number of conditions that causes BXO. […] Balanitis xerotica obliterans (BXO) is a term used to describe chronic, often progressive inflammation of the glans penis, which can lead to phimosis and urethral stenosis, affecting both urinary and sexual function. […] In persistent and recalcitrant (poor response to treatment) cases a biopsy is usually needed to look for lichen sclerosus, erythroplasia of Queyrat, and squamous cell carcinoma; a confident clinical diagnosis is not always possible or safe. […] The main aims of management are to make the skin more comfortable, minimise urinary and sexual dysfunction, and to exclude premalignant/malignant disease. […] If the 'balanitis’ does not improve with the treatments referred to above then it is important to consider lichen sclerosus, penile intraepithelial neoplasia, and occasionally squamous cell carcinoma. Manage accordingly.

• #47 Pathology Outlines – Balanitis / phimosis

  https://www.pathologyoutlines.com/topic/penscrotumbalanoposthitis.html

  Phimosis may be the result of recurrent infections (such as balanoposthitis) causing scarring of the preputial ring (Kumar: Robbins & Cotran Pathologic Basis of Disease, 10th Edition, 2020) […] Usually results from an inflammatory reaction to accumulated smegma (Weidner: Modern Surgical Pathology, 2nd Edition, 2009) […] Bacteria adhere and colonize the mucosal surface of the prepuce (Kradin: Diagnostic Pathology of Infectious Disease, 2nd Edition, 2017) […] Balanoposthitis is inflammation of the mucosa of the glans and prepuce of the penis […] Nonspecific inflammatory infiltrate with lymphocytes and plasma cells […] Patterns of inflammation include lichenoid and intraepithelial […] Epidermis: thin with possible ulceration and flattened or diamond shaped keratinocytes with intercellular edema […] Upper dermis: band-like infiltrate containing plasma cells (variable amount) […] Dermis: dilated capillaries with adjacent extravasated red blood cells and hemosiderin deposition.

• #48 Balanitis: What Causes It and How To Treat It

  https://patient.info/mens-health/penis-problems/balanitis

  This affects middle-aged and older men, usually if they are not circumcised. The foreskin does not function properly and dead skin cells, urine, soap particles and other debris are trapped under the foreskin. This leads to irritation of the foreskin and the head of the penis under it. It is not caused by a penis infection. […] A doctor can easily diagnose balanitis by the red and inflamed look of the end of the penis (the glans). […] The treatment depends on the cause of the balanitis. The doctor will often prescribe: An anti-fungal cream or a course of anti-yeast tablets is a common balanitis treatment if it is caused by candida. […] It is unusual for a child to have recurring balanitis. Your GP may ask a specialist to advise. If you are an adult with a recurring problem and have a condition where the foreskin does not pull back (retract) over the glans (a phimosis), an option is to be circumcised to remove the foreskin.

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