Balanitis Circumscripta Plasmacellularis Treatment & Management
- Author: Noah S Scheinfeld, JD, MD, FAAD; Chief Editor: Dirk M Elston, MD more...
Topical tacrolimus ointment has been reported useful for Zoon balanitis.[22, 23, 24] In 2008, Virgili et al 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 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 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 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. 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). Griseofulvin therapy and oral tetracycline have been tried without success.
The treatment of choice for balanitis circumscripta plasmacellularis (plasma cell balanitis) is circumcision, which is usually curative.[31, 32, 33] 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. Retamar et al 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. New treatment options include photodynamic therapy[36, 36] and the ablative YAG laser. The 2103 European Guidelines are firm that circumcision is the definitive treatment for Zoon balanitis. It was also noted again in 2014 that Zoon balanitis is not an infection.
An interesting case Zoon balanitis was a male HIV-positive teenaged patient using circumcision as treatment and a cure after topical treatment was noted in 2013.
Palminteri et al 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.
Consultation with a urologist may be helpful.
Zoon JJ. [Chronic benign circumscript plasmocytic balanoposthitis.]. Dermatologica. 1952. 105(1):1-7. [Medline].
Mallon E, Hawkins D, Dinneen M, et al. Circumcision and genital dermatoses. Arch Dermatol. 2000 Mar. 136(3):350-4. [Medline].
Adégbidi H, Atadokpèdé F, Dégboé B, Saka B, Akpadjan F, Yédomon H, et al. Zoon's balanitis in circumcised and HIV infected man, at Cotonou (Benin). Bull Soc Pathol Exot. 2014 Aug;. 107(3):139-41. [Medline].
Pearce J, Fernando I. The value of a multi-specialty service, including genitourinary medicine, dermatology and urology input, in the management of male genital dermatoses. Int J STD AIDS. 2015 Sep. 26 (10):716-22. [Medline].
Toker SC, Baskan EB, Tunali S, Yilmaz M, Karadogan SK. Zoon's balanitis in a circumcised man. J Am Acad Dermatol. 2007 Aug. 57(2 Suppl):S6-7. [Medline].
Davis-Daneshfar A, Trueb RM. Bowen's disease of the glans penis (erythroplasia of Queyrat) in plasma cell balanitis. Cutis. 2000 Jun. 65(6):395-8. [Medline].
Starritt E, Lee S. Erythroplasia of Queyrat of the glans penis on a background of Zoon's plasma cell balanitis. Australas J Dermatol. 2008 May. 49(2):103-5. [Medline].
García-Abós M, Fraga J, Daudén E. [Mucinous metaplasia of the penis associated with Zoon's balanitis]. Actas Dermosifiliogr. 2010 May. 101(4):362-4. [Medline].
Fernández-Aceñero MJ, Córdova S. Zoon's vulvitis (vulvitis circumscripta plasmacellularis). Arch Gynecol Obstet. 2010 Sep. 282(3):351-2. [Medline].
Kumar B, Narang T, Dass Radotra B, Gupta S. Plasma cell balanitis: clinicopathologic study of 112 cases and treatment modalities. J Cutan Med Surg. 2006 Jan-Feb. 10(1):11-5. [Medline].
Kiene P, Fölster-Holst R. No evidence of human papillomavirus infection in balanitis circumscripta plasmacellularis Zoon. Acta Derm Venereol. 1995 Nov. 75(6):496-7. [Medline].
Erdogan BS, Demirkan N, Aktan S, Ergin S, Evliyaoglu D. A focus on differential diagnosis of lichen planus and plasma cell balanitis. J Eur Acad Dermatol Venereol. 2006 Jul. 20(6):746-8. [Medline].
Kossard S, Shumack S. Lichen aureus of the glans penis as an expression of Zoon's balanitis. J Am Acad Dermatol. 1989 Oct. 21(4 Pt 1):804-6. [Medline].
Houser ER, Gaston KE, Funkhouser WK, Israel B, Lavelle JP. Plasma cell (Zoon's) balanitis with concomitant HIV infection. Urology. 2005 Sep. 66(3):657. [Medline].
Babu CS, Vitharana S, Higgins SP. Primary syphilis presenting as balanitis. Int J STD AIDS. 2007 Jul. 18(7):497-8. [Medline].
Vartolomei MD, Cotoi OS, Badea MA, Chibelean CB, Cotoi T, Morariu V, et al. Indurative Edema of the Prepuce Mimicing Phimosis, an Atypical Manifestation of Primary Syphilis. Acta Dermatovenerol Croat. 2015 Dec. 23 (4):301-3. [Medline].
Arzberger E, Komericki P, Ahlgrimm-Siess V, Massone C, Chubisov D, Hofmann-Wellenhof R. Differentiation Between Balanitis and Carcinoma In Situ Using Reflectance Confocal Microscopy. JAMA Dermatol. 2013 Jan 16. 1-6. [Medline].
Alessi E, Coggi A, Gianotti R. Review of 120 biopsies performed on the balanopreputial sac. from zoon's balanitis to the concept of a wider spectrum of inflammatory non-cicatricial balanoposthitis. Dermatology. 2004. 208(2):120-4. [Medline].
Weyers W, Ende Y, Schalla W, Diaz-Cascajo C. Balanitis of Zoon: a clinicopathologic study of 45 cases. Am J Dermatopathol. 2002 Dec. 24(6):459-67. [Medline].
Brix WK, Nassau SR, Patterson JW, Cousar JB, Wick MR. Idiopathic lymphoplasmacellular mucositis-dermatitis. J Cutan Pathol. 2010 Apr. 37(4):426-31. [Medline].
Hernandez-Machin B, Hernando LB, Marrero OB, Hernandez B. Plasma cell balanitis of Zoon treated successfully with topical tacrolimus. Clin Exp Dermatol. 2005 Sep. 30(5):588-9. [Medline].
Roe E, Dalmau J, Peramiquel L, Perez M, Lopez-Lozano HE, Alomar A. Plasma cell balanitis of zoon treated with topical tacrolimus 0.1%: report of three cases. J Eur Acad Dermatol Venereol. 2007 Feb. 21(2):284-5. [Medline].
Moreno-Arias GA, Camps-Fresneda A, Llaberia C, Palou-Almerich J. Plasma cell balanitis treated with tacrolimus 0.1%. Br J Dermatol. 2005 Dec. 153(6):1204-6. [Medline].
Virgili A, Mantovani L, Lauriola MM, Marzola A, Corazza M. Tacrolimus 0.1% ointment: is it really effective in plasma cell vulvitis? Report of four cases. Dermatology. 2008. 216(3):243-6. [Medline].
Bardazzi F, Antonucci A, Savoia F, Balestri R. Two cases of Zoon's balanitis treated with pimecrolimus 1% cream. Int J Dermatol. 2008 Feb. 47(2):198-201. [Medline].
Stinco G, Piccirillo F, Patrone P. Discordant results with pimecrolimus 1% cream in the treatment of plasma cell balanitis. Dermatology. 2009. 218(2):155-8. [Medline].
Nasca MR, De Pasquale R, Micali G. Treatment of Zoon's balanitis with imiquimod 5% cream. J Drugs Dermatol. 2007 May. 6(5):532-4. [Medline].
Petersen CS, Thomsen K. Fusidic acid cream in the treatment of plasma cell balanitis. J Am Acad Dermatol. 1992 Oct. 27(4):633-4. [Medline].
Morioka S, Nakajima S, Yaguchi H, Naito K, Iwahara K, Ogawa H. Vulvitis circumscripta plasmacellularis treated successfully with interferon alpha. J Am Acad Dermatol. 1988 Nov. 19(5 Pt 2):947-50. [Medline].
Ferrándiz C, Ribera M. Zoon's balanitis treated by circumcision. J Dermatol Surg Oncol. 1984 Aug. 10(8):622-5. [Medline].
Kumar B, Sharma R, Rajagopalan M, Radotra BD. Plasma cell balanitis: clinical and histopathological features--response to circumcision. Genitourin Med. 1995 Feb. 71(1):32-4. [Medline].
Sonnex TS, Dawber RP, Ryan TJ, Ralfs IG. Zoon's (plasma-cell) balanitis: treatment by circumcision. Br J Dermatol. 1982 May. 106(5):585-8. [Medline].
Baldwin HE, Geronemus RG. The treatment of Zoon's balanitis with the carbon dioxide laser. J Dermatol Surg Oncol. 1989 May. 15(5):491-4. [Medline].
Retamar RA, Kien MC, Chouela EN. Zoon's balanitis: presentation of 15 patients, five treated with a carbon dioxide laser. Int J Dermatol. 2003 Apr. 42(4):305-7. [Medline].
Pinto-Almeida T, Vilaca S, Amorim I, et al. Complete resolution of Zoon balanitis with photodynamic therapy - a new therapeutic option?. Eur J Dermatol. 2012 Jun 11. [Medline].
Wollina U. Ablative erbium:YAG laser treatment of idiopathic chronic inflammatory non-cicatricial balanoposthitis (Zoon's disease)--a series of 20 patients with long-term outcome. J Cosmet Laser Ther. Jun 2010. 12:120-3. [Medline].
[Guideline] Edwards S, Bunker C, Ziller F, van der Meijden WI. 2013 European guideline for the management of balanoposthitis. Int J STD AIDS. 2014 May 14. 25(9):615-626. [Medline].
Andreassi L, Bilenchi R. Non-infectious inflammatory genital lesions. Clin Dermatol. 2014 Mar-Apr. 32(2):307-14. [Medline].
Pileggi Fde O, Nogueira PL, de Melo Coelho MF, da Silveira Orsi G, de Fatima Gali Sorita Tazima M, Vicente YA, et al. Circumcision as treatment for Zoon's balanitis in an HIV-positive teenage patient. Int J STD AIDS. 2013 Oct. 24(10):837-9. [Medline].
Palminteri E, Berdondini E, Lazzeri M, Mirri F, Barbagli G. Resurfacing and reconstruction of the glans penis. Eur Urol. 2007 Sep. 52(3):893-8. [Medline].