Balanitis Circumscripta Plasmacellularis Clinical Presentation

Updated: Nov 18, 2019
  • Author: Elizabeth J Usedom, MD, MS; Chief Editor: Dirk M Elston, MD  more...
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Presentation

History

The patient, an uncircumcised male of middle age or older, usually presents with a characteristic lesion of the glans penis or prepuce, present for an average of 1-2 years before diagnosis. Symptoms are minimal, but patients may report mild pruritus or tenderness. Some patients present for evaluation because of cosmetic concerns or anxiety. Bloodstaining of the underclothes for 5 months prior to presentation has been reported in a patient with balanitis circumscripta plasmacellularis (plasma cell balanitis). In 2007, Toker et al reported on plasma cell balanitis in a circumcised man, although the study hypothesized that the initial circumcision may have been inadequately performed, supporting the etiology of a dysfunctional foreskin. [11]

Erythroplasia of Queyrat (squamous cell carcinoma in situ) of the glans penis on a background of Zoon plasma cell balanitis has been noted and can complicate the diagnosis and necessitating biopsy. [12, 13]

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Physical Examination

The balanitis circumscripta plasmacellularis (plasma cell balanitis) lesion is usually a solitary, shiny, red-to-orange patch or plaque of the glans or prepuce of an uncircumcised male. The lesions may exhibit a yellowish hue with pinpoint purpuric "cayenne pepper" spotting. Erosive and vegetative variants have been reported. Bowen disease of the glans penis (erythroplasia of Queyrat) has been reported in association with plasma cell balanitis. Additionally, it is very difficult to distinguish this entity from erythroplasia of Queyrat clinically; thus, attention must be given to possible neoplastic associations with this condition and a biopsy should be considered. Plasma cell balanitis is most common on the penis in men, [14] and, in women, when it is on the vulva, it is termed vulvitis circumscripta plasmacellularis. [15]

Kumar et al studied 112 persons with a clinical diagnosis of plasma cell balanitis ranging in age from 24-70 years. [16] Most had been symptomatic for more than 12 months. Plaques manifested on the prepuce and glans in 58.92% of patients, in the prepuce only in 23.21% of patients, and on the glans only in 17.85% patients.

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