Balanitis Circumscripta Plasmacellularis Treatment & Management

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

Medical Care

The first step in management should focus on good hygiene. [27]  This includes regular retraction of the foreskin and gentle cleansing of the entirety of the penis.

Several classes of medications shown to be effective in balanitis circumscripta plasmacellularis (plasma cell balanitis): topical calcineurin inhibitors (tacrolimus and pimecrolimus), topical steroids, topical imiquimod, and topical mupirocin.

Topical tacrolimus 0.03-0.1% ointment twice daily has been reported to be useful for plasma cell balanitis in multiple studies. [28, 29, 30] 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 plasma cell balanitis in men. [31]

Bardazzi et al evaluated pimecrolimus 1% cream twice daily for treating resistant plasma cell balanitis in two patients. [32] One patient had 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 three patients with plasma cell balanitis refractory to several treatments with steroids and antifungals and twice-daily pimecrolimus 1%. [33] Of the three, one had 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.

Topical moderately potent steroids steroids have been effective alone or in combination with topical antibiotics. Tang et al described clinical response within 3-12 weeks with clobetasol butyrate 0.05% cream, nystatin 100,000 units/g, and oxytetracycline 3%. [34] Yoganathan et al described only 50% response to saline compresses with a variety of combination steroid preparations. [35]

Nasca et al described a 43-year-old, uncircumcised, white, diabetic man with a 4-year history of plasma cell balanitis that was unresponsive to topical steroid therapy. [36] He experienced a clinical but not histological cure after 16 weeks of imiquimod 5% three times weekly, with multiple periods without therapy for several days' duration owing to an adverse cutaneous reaction. An additional study showed complete resolution after 12 weeks of imiquimod 5% three times weekly without interruption. [37]

Fusidic acid cream 2% has been reported as effective in disease suppression and curative in some patients. [38] Topical agents including antibacterials, gentian violet, and antifungal agents have been used with only limited success in patients with plasma cell balanitis and are not curative. Intralesional interferon-alfa was found to be helpful in treatment of the vulvar analog of plasma cell balanitis. [39] Griseofulvin therapy and oral tetracycline have been tried without success.

Next:

Surgical Care

The treatment of choice for balanitis circumscripta plasmacellularis (plasma cell balanitis) is circumcision, which usually is curative. [40, 41, 42, 43] 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 plasma cell balanitis lesions. [44] Retamar et al treated five patients with a carbon dioxide laser, [45] and three were free from disease years later. Radiotherapy and electrodesiccation have been used with less than optimal results. Other treatment options include photodynamic therapy [46] and the ablative YAG laser. [47] The 2103 European Guidelines are firm that circumcision is the definitive treatment for plasma cell balanitis. [27] It was also noted again in 2014 that plasma cell balanitis is not an infection. [48]

Palminteri et al noted that in selected cases of benign, premalignant, or malignant penile lesions (including those related to plasma cell balanitis), [49] glans resurfacing or reconstruction can ensure a normal-appearing and functional penis, without jeopardizing cancer control.

Previous
Next:

Consultations

Consultation with a urologist may be helpful.

Previous