eMedicine Specialties > Dermatology > Reactive & Inflammatory Dermatoses
Balanitis Circumscripta Plasmacellularis
Updated: Jan 7, 2010
Introduction
Background
In 1952, J.J. Zoon1 first recognized balanitis circumscripta plasmacellularis (plasma cell balanitis) is an idiopathic, rare, benign penile dermatosis. Balanitis circumscripta plasmacellularis is important to distinguish this benign condition from the clinically similar neoplastic erythroplasia of Queyrat.
Immunohistologically, immunoglobulin E and immunoglobulin G are found to be major immunoglobulin classes in the plasma cellular infiltrate. Immunoglobulin M–positive cells are either absent or present in very low numbers. Although a specific allergen has not been identified, the findings suggest that this condition could be related to immediate hypersensitivity.
The kappa-to-lambda ratio is variable. This suggests a nonspecific polyclonal stimulation of B cells in the basis of balanitis circumscripta plasmacellularis (plasma cell balanitis), which might be caused by a persistent infection.
Other related eMedicine articles include Bowen Disease, Lichen Sclerosus et Atrophicus, Erythroplasia of Queyrat (Bowen Disease of the Glans Penis), Balanitis Xerotica Obliterans, and Balanitis.
Frequency
International
Mallon et al2 studied 357 male referral patients with genital skin disease. They studied a control group of 305 male dermatology clinic patients without genital skin disease over a 120-day period. Their goal was to investigate the relationship between circumcision and penile disease. Mallon et al2 compiled the percentage of circumcision in the general male dermatology population. Zoon balanitis occurred in 27 patients. More patients had squamous cell carcinoma, bowenoid papulosis, and Bowen disease. They noted that every patient with Zoon balanitis, bowenoid papulosis, and nonspecific balanoposthitis had not been circumcised.
Sex
Balanitis circumscripta plasmacellularis (plasma cell balanitis) affects males. Analogous lesions sharing both clinical and histologic features of balanitis circumscripta plasmacellularis (plasma cell balanitis) have been reported in women as vulvitis circumscripta plasmacellularis.
Age
Balanitis circumscripta plasmacellularis (plasma cell balanitis) is most common in middle-aged to older men, with cases reported in patients aged 20-88 years.
Clinical
History
The patient, a male of middle age or older, usually presents with a characteristic lesion of the glans penis or prepuce, present for an average of 1-2 years before diagnosis. Symptoms are minimal, but patients may complain of mild pruritus or tenderness. Some patients present for evaluation because of cosmetic concerns or anxiety. Bloodstaining of the underclothes for 5 months prior to presentation has been reported in a patient with balanitis circumscripta plasmacellularis (plasma cell balanitis). In 2007, Toker et al3 reported on Zoon balanitis in a circumcised man.
Erythroplasia of Queyrat (squamous cell carcinoma in situ) of the glans penis on a background of Zoon plasma cell balanitis has been noted and can complicate diagnosis.4,5
Physical
The balanitis circumscripta plasmacellularis (plasma cell balanitis) lesion is usually a solitary, glistening, shiny, red-to-orange plaque of the glans or prepuce of an uncircumcised male. The lesions may exhibit a yellowish hue with pinpoint purpuric "cayenne pepper" spotting. Erosive and vegetative variants have been reported. Bowen disease of the glans penis (erythroplasia of Queyrat) has been reported in association with balanitis circumscripta plasmacellularis (plasma cell balanitis); thus, attention must be given to possible neoplastic associations with this condition.
Kumar et al6 studied 112 persons with a clinical diagnosis of balanitis circumscripta plasmacellularis (plasma cell balanitis) ranging in age from 24-70 years. Most had been symptomatic for more than 12 months. Plaques manifested on the prepuce and glans in 58.92% of patients, in the prepuce only in 23.21% of patients, and on the glans only in 17.85% patients.
Causes
The etiology of balanitis circumscripta plasmacellularis (plasma cell balanitis) is unknown. Importantly, all confirmed cases have been in uncircumcised males. It has been proposed that friction, trauma, heat, poor hygiene, chronic infection with Mycobacterium smegmatis, a reactive response to an unknown exogenous or infectious agent, an immediate hypersensitivity response mediated by immunoglobulin E class antibodies, and hypospadias may be predisposing or inciting agents. No evidence suggests human papilloma virus infection in balanitis circumscripta plasmacellularis (plasma cell balanitis).7
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References
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Further Reading
Keywords
balanitis circumscripta plasmacellularis, plasma cell balanitis, Zoon balanitis, plasma cell mucositis
Overview: Balanitis Circumscripta Plasmacellularis