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Balanitis Circumscripta Plasmacellularis Treatment & Management

  • Author: Noah S Scheinfeld, JD, MD, FAAD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Feb 09, 2016
 

Medical Care

Topical tacrolimus ointment has been reported useful for Zoon balanitis.[22, 23, 24] In 2008, Virgili et al[25] 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[26] 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[27] 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[28] 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.[29] 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).[30] 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.[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.[34] Retamar et al[35] 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.[37] The 2103 European Guidelines are firm that circumcision is the definitive treatment for Zoon balanitis.[38] It was also noted again in 2014 that Zoon balanitis is not an infection.[39]

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.[40]

Palminteri et al[41] 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, JD, MD, FAAD Assistant Clinical Professor, Department of Dermatology, Weil Cornell Medical College; Consulting Staff, Department of Dermatology, St Luke's Roosevelt Hospital Center, Beth Israel Medical Center, New York Eye and Ear Infirmary; Assistant Attending Dermatologist, New York Presbyterian Hospital; Assistant Attending Dermatologist, Lenox Hill Hospital, North Shore-LIJ Health System; Private Practice

Noah S Scheinfeld, JD, MD, FAAD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Abbvie<br/>Received income in an amount equal to or greater than $250 from: Optigenex<br/>Received salary from Optigenex for employment.

Specialty Editor Board

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, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

Rosalie Elenitsas, MD Herman Beerman 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, American Medical Association, American Society of Dermatopathology, Pennsylvania Academy of Dermatology

Disclosure: Received royalty from Lippincott Williams Wilkins for textbook editor.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

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

Disclosure: Nothing to disclose.

Additional Contributors

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 Federation for Medical Research, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Acknowledgements

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.

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