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Balanoposthitis Clinical Presentation

  • Author: Vladimir O Osipov, MD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Nov 20, 2015
 

History

In adults, a detailed clinical history focusing on topical irritants and home remedies assists in making the correct diagnosis and in detecting possible contact dermatitides.

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Physical

Examination of the glans and the prepuce often reveals a red, moist macular lesion. Associated erythema is noted, and areas of yellow-to-black discoloration have been described.[22]  The presence of lichenification, irregular borders, or acetowhite changes with 5% acetic acid treatment suggest an HPV infection, which can be seen in association with balanoposthitis.

A superimposed balanoposthitis on a flat condyloma has been described. Such coexisting lesions may be diagnosed based on the clinical history and a culture of fungus or bacteria from the ulcer.

Ulceration and deep erosion have been seen in patients with advanced disease, often in association with fungal infections and in individuals who are immunocompromised.

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Causes

In a study conducted by Alsterholm et al, patients with balanoposthitis had a significantly higher frequency of positive cultures than in the control group (59% and 35%, respectively, P < .05).[23] In the balanoposthitis group, Staphylococcus aureus was found in 19%, group B streptococci in 9%, Candida albicans in 18%, and Malassezia in 23% of patients. In the control group, S aureus was not found at all, whereas C albicans was found in 7.7% and Malassezia in 23% of patients. Different microbes did not correspond with distinct clinical manifestations.

Although not shown to be a direct cause, an association exists between nonspecific balanoposthitis and the uncircumcised penis. Mallon et al have proposed that circumcision may protect against balanoposthitis and common penile infections.[24] Rare causes include a contact-induced balanoposthitis from the application of celandine juice (from the plant Chelidonium majus). An association with preputial smegma stones has been described, a correlation that most likely reflects the hygiene of the affected population.[25] Granulomatous balanoposthitis has occurred after intravesicle BCG treatment of urothelial cancer.[26]

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Contributor Information and Disclosures
Author

Vladimir O Osipov, MD Pathologist In Charge, QML Townsville

Vladimir O Osipov, MD is a member of the following medical societies: American Society for Clinical Pathology, United States and Canadian Academy of Pathology, Royal College of Pathologists of Australasia, College of American Pathologists

Disclosure: Nothing to disclose.

Coauthor(s)

Milton W Datta, MD Assistant Professor, Departments of Pathology, Urology, and Hematology-Oncology, Emory University School of Medicine

Milton W Datta, MD is a member of the following medical societies: College of American Pathologists, United States and Canadian Academy of Pathology

Disclosure: Nothing to disclose.

Peter Langenstroer, MD Associate Professor, Department of Urology, Medical College of Wisconsin

Peter Langenstroer, MD is a member of the following medical societies: American Urological Association

Disclosure: Nothing to disclose.

Scott M Acker, MD Associate Professor, Director of Dermatopathology, Departments of Dermatology and Pathology, University of Alabama at Birmingham

Scott M Acker, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, American Society for Clinical Pathology, Southern Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Jeffrey Meffert, MD Associate Clinical Professor of Dermatology, University of Texas School of Medicine at San Antonio

Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

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

Abdul-Ghani Kibbi, MD Professor and Chair, Department of Dermatology, American University of Beirut Medical Center, Lebanon

Disclosure: Nothing to disclose.

References
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