Balanitis Circumscripta Plasmacellularis Treatment & Management

  • Author: Noah S Scheinfeld, MD, JD, FAAD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Aug 2, 2011
 

Medical Care

Topical tacrolimus ointment has been reported useful for Zoon balanitis.[18, 19, 20] In 2008, Virgili et al[21] reported in a comparative analysis of subjective, objective, and histopathological data that topical tacrolimus was less effective in treating plasma cell vulvitis compared with Zoon balanitis in men.

Also in 2008, Bardazzi et al[22] evaluated pimecrolimus 1% cream for treating resistant Zoon balanitis in 2 patients. One patient had a complete regression of the lesion after 2 months of therapy, and the other had great improvement of the lesion but a hyperpigmented patch persisted on the glans. Similarly, Stinco et al[23] in 2009 noted a series of 3 patients with Zoon balanitis refractory to several treatments with steroids and antifungals and twice-daily pimecrolimus 1%. Of the 3, one had a complete resolution, one responded but relapsed after treatment was stopped, and the last had a partial response but stopped treatment because of adverse drug effects.

In 2007, Nasca et al[24] described a 43-year-old, uncircumcised, white, diabetic man with a 4-year history of Zoon balanitis that was unresponsive to topical steroid therapy. He experienced a clinical but not histological cure after 16 weeks of thrice-weekly imiquimod 5% therapy, with no relapses at 18-month follow-up. A moderate-to-marked cutaneous inflammation occurred several times during treatment, which required rest periods of several days' duration.

Fusidic acid cream 2% has been reported as effective in disease suppression and curative in some patients.[25] Topical agents such as corticosteroids, antibacterials, gentian violet, and antifungal agents have been used with only limited success in patients with balanitis circumscripta plasmacellularis (plasma cell balanitis) and are not curative. Intralesional interferon alpha was found to be helpful in the treatment of the vulvar analog of balanitis circumscripta plasmacellularis (plasma cell balanitis).[26] Griseofulvin therapy and oral tetracycline have been tried without success.

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Surgical Care

The treatment of choice for balanitis circumscripta plasmacellularis (plasma cell balanitis) is circumcision, which is usually curative.[27, 28, 29] Patients must be informed that circumcision is the current criterion standard for the treatment of this disorder. The carbon dioxide laser has been used successfully in ablation of balanitis circumscripta plasmacellularis (plasma cell balanitis) lesions.[30] Retamar et al[31] treated 5 patients with a carbon dioxide laser, and 3 were free from disease years later. Radiotherapy and electrodesiccation have been used with less than optimal results.

Palminteri et al[32] noted that in selected cases of benign, premalignant, or malignant penile lesions (including that related to Zoon balanitis), glans resurfacing or reconstruction can ensure a normal-appearing and functional penis, without jeopardizing cancer control.

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Consultations

Consultation with a urologist may be helpful.

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Contributor Information and Disclosures
Author

Noah S Scheinfeld, MD, JD, FAAD  Assistant Clinical Professor, Department of Dermatology, Columbia University College of Physicians and Surgeons; Consulting Staff, Department of Dermatology, St Luke's Roosevelt Hospital Center, Beth Israel Medical Center, and 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.

Specialty Editor Board

Janet Fairley, MD  Professor and Head, Department of Dermatology, University of Iowa, Roy J and Lucille A Carver College of Medicine

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.

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster 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.

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: Lippincott Williams Wilkins Royalty Textbook editor; DLA Piper Consulting fee Consulting

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, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

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