eMedicine Specialties > Dermatology > Reactive & Inflammatory Dermatoses

Balanoposthitis: Differential Diagnoses & Workup

Author: Vladimir O Osipov, MD, Assistant Professor, Department of Pathology, Section of Bone and Soft Tissue Pathology, Section of Gastrointestinal Pathology, Medical College of Wisconsin
Coauthor(s): Scott M Acker, MD, Associate Professor, Director of Dermatopathology, Departments of Dermatology and Pathology, University of Alabama at Birmingham; Peter Langenstroer, MD, Associate Professor, Department of Urology, Medical College of Wisconsin; Milton W Datta, MD, Assistant Professor, Departments of Pathology, Urology, and Hematology-Oncology, Emory University School of Medicine
Contributor Information and Disclosures

Updated: Mar 30, 2009

Differential Diagnoses

Bowen Disease
Candidiasis, Cutaneous
Contact Dermatitis, Irritant
Erythroplasia of Queyrat (Bowen Disease of the Glans Penis)
Intertrigo
Lichen Sclerosus et Atrophicus

Other Problems to Be Considered

Candidal, viral, or fungal infections
Zoon balanitis (balanitis circumscripta plasma cellularis)
Ulcerating lesions of the penis (may result from bites with subsequent infection by oral flora)
HPV infection, in particular flat condylomas23
Amebiasis (rare; usually in homosexual men; suspect in patients with poor response to antibiotics)24
Trophozoites (examination is confirmatory)
Pilonidal sinus of the penis (rare; presenting at the coronal sulcus)25

Workup

Laboratory Studies

  • Potassium hydroxide (KOH) slide preparation and culture for Candida species
    • A KOH preparation allows for the rapid visualization of the candidal hyphae.
    • Culture often isolates candidal species in these cases and helps to direct proper treatment.

Imaging Studies

  • No imaging studies are indicated.

Other Tests

  • Rarely, serologic tests for candidal species may be indicated, particularly in unclear cases and for academic interest.

Procedures

  • Biopsy from the involved area
    • Biopsy is performed in doubtful cases and if antifungal treatment fails to produce a favorable response.
    • A biopsy is especially warranted if premalignant or malignant lesions, such as erythroplasia of Queyrat or Bowen disease, are suspected and need to be excluded.

Histologic Findings

The histologic findings are nonspecific and eczematous in nature. Dermis contains lymphoplasmacytic infiltrates. Special stains for fungi, such as the periodic acid-Schiff (PAS) stain, may exhibit fungal elements characteristic of candidal organisms.

Dermis with lymphoplasmacytic infiltrates and dil...

Dermis with lymphoplasmacytic infiltrates and dilated blood vessels.

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Dermis with lymphoplasmacytic infiltrates and dil...

Dermis with lymphoplasmacytic infiltrates and dilated blood vessels.


More on Balanoposthitis

Overview: Balanoposthitis
Differential Diagnoses & Workup: Balanoposthitis
Treatment & Medication: Balanoposthitis
Follow-up: Balanoposthitis
Multimedia: Balanoposthitis
References
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References

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Further Reading

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Keywords

balanoposthitis, inflammation of the foreskin and glans, glans penis inflammation, foreskin inflammation

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Contributor Information and Disclosures

Author

Vladimir O Osipov, MD, Assistant Professor, Department of Pathology, Section of Bone and Soft Tissue Pathology, Section of Gastrointestinal Pathology, Medical College of Wisconsin
Vladimir O Osipov, MD is a member of the following medical societies: American Society for Clinical Pathology, College of American Pathologists, and United States and Canadian Academy of Pathology
Disclosure: Nothing to disclose.

Coauthor(s)

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, and Southern Medical Association
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.

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 and United States and Canadian Academy of Pathology
Disclosure: Nothing to disclose.

Medical Editor

Abdul-Ghani Kibbi, MD, Chairman and Professor, Department of Dermatology, American University of Beirut Medical Center, Lebanon
Disclosure: none None None

Pharmacy Editor

Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center
Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Jeffrey Meffert, MD, Assistant Clinical Professor of Dermatology, University of Texas Health Science Center-San Antonio
Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, and Texas Dermatological Society
Disclosure: Nothing to disclose.

CME Editor

Joel M Gelfand, MD, MSCE, Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania
Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology
Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds None; Genentech Consulting fee Consulting; Centocor Consulting fee Consulting; Centocor Grant/research funds None; Covance Consulting fee Consulting; Shire  Consulting

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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