eMedicine Specialties > Dermatology > Reactive & Inflammatory Dermatoses

Balanitis Circumscripta Plasmacellularis

Author: Noah S Scheinfeld, MD, JD, FAAD, Assistant Clinical Professor, Department of Dermatology, Columbia University; Consulting Staff, Department of Dermatology, St Luke's Roosevelt Hospital Center, Beth Israel Medical Center, New York Eye and Ear Infirmary; Private Practice
Coauthor(s): George C Keough, MD, Chief, Clinical Assistant Professor, Department of Medicine, Dermatology Service, Eisenhower Army Medical Center; Daniel S Lehman, MD, Fellow in Minimally Invasive Urology/Oncology, Department of Urology, Columbia University Medical Center
Contributor Information and Disclosures

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

More on Balanitis Circumscripta Plasmacellularis

Overview: Balanitis Circumscripta Plasmacellularis
Differential Diagnoses & Workup: Balanitis Circumscripta Plasmacellularis
Treatment & Medication: Balanitis Circumscripta Plasmacellularis
Follow-up: Balanitis Circumscripta Plasmacellularis
References
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References

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Further Reading

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Keywords

balanitis circumscripta plasmacellularis, plasma cell balanitis, Zoon balanitis, plasma cell mucositis

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Contributor Information and Disclosures

Author

Noah S Scheinfeld, MD, JD, FAAD, Assistant Clinical Professor, Department of Dermatology, Columbia University; Consulting Staff, Department of Dermatology, St Luke's Roosevelt Hospital Center, Beth Israel Medical Center, New York Eye and Ear Infirmary; Private Practice
Noah S Scheinfeld, MD, JD, FAAD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Optigenex Consulting fee Independent contractor

Coauthor(s)

George C Keough, MD, Chief, Clinical Assistant Professor, Department of Medicine, Dermatology Service, Eisenhower Army Medical Center
George C Keough, MD is a member of the following medical societies: American Academy of Dermatology and American Medical Association
Disclosure: Nothing to disclose.

Daniel S Lehman, MD, Fellow in Minimally Invasive Urology/Oncology, Department of Urology, Columbia University Medical Center
Disclosure: Nothing to disclose.

Medical Editor

Janet Fairley, MD, Professor and Head, Department of Dermatology, University of Iowa
Janet Fairley, MD is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, American Federation for Medical Research, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

Pharmacy Editor

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA
Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Rosalie Elenitsas, MD, Herman Beerman Associate Professor of Dermatology, University of Pennsylvania School of Medicine; Director, Penn Cutaneous Pathology Services, Department of Dermatology, University of Pennsylvania Health System
Rosalie Elenitsas, MD is a member of the following medical societies: American Academy of Dermatology and American Society of Dermatopathology
Disclosure: Nothing to disclose.

CME Editor

Catherine M Quirk, MD, Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania
Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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