Balanitis Treatment & Management

Updated: Nov 28, 2018
  • Author: Mark J Leber, MD, MPH; Chief Editor: Erik D Schraga, MD  more...
  • Print
Treatment

Emergency Department Care

Patients presenting with balanitis but without phimosis should receive the following recommendations and treatment [5, 23] :

  • Gentle retraction of the foreskin daily and soak in warm water to clean penis and foreskin.

  • In pediatric patients and patients with mild balanitis xerotica, a 2-month trial of antifungals may be attempted; the patient or mother should retract the foreskin gently and apply 0.05% betamethasone twice a day. This applies to children older than 3 years. Success is seen particularly in male children older than 10 years compared with those aged 3-10 years. Success ranges from 65-95%.

  • Topical steroids have had only limited success in patients with moderate-to-severe balanitis xerotica obliterans. These patients are more likely to have distal scarring of the foreskin.

  • In recurrent cases, 1% pimecrolimus cream was used instead of steroids, with a 64% success rate. [24]

  • Apply bacitracin (not Neosporin) for pediatric patients if bacterial infection is suspected.

  • Apply topical clotrimazole for adult men with probable candidal balanitis.

  • Obtain a culture of discharge in complicated cases such as those with associated cellulitis, then treat empirically with appropriate antibiotics (typically first-generation cephalosporin).

  • A study of 1185 boys concluded that fluticasone proprionate 0.05% was effective and safe in treating associated phimosis, with successful results in 91.1% of patients. [25]

Patients presenting to the ED with phimosis and severe urinary obstruction as a complication of balanitis should receive the following care (recommended that surgical intervention be performed by a urologist, if available):

  • Steroid cream and gentle retraction of the foreskin, if the phimosis is not too tight, may be used before surgery is contemplated. [26, 27]

  • Without damaging the glans penis, dilate the foreskin using a clamp. If the glans penis is adherent to the foreskin, the procedure may be contraindicated. Local anesthesia, analgesia, and/or sedation may be required.

  • Perform a dorsal slit incision by cutting the foreskin over the dorsal shaft of the penis to enlarge the foreskin opening. This procedure requires local anesthesia and, possibly, sedation.

  • Perform a formal circumcision (preferably in the operating room). [28, 29]

  • Circumcision is not a preventive treatment of balanitis in those younger than 3 years.

Consult a urologist if a dorsal slit incision or circumcision is contemplated.

Deterrence/prevention of balanitis includes the following measures:

  • Proper personal hygiene

  • Control of diabetes and other chronic medical disorders

  • Weight reduction for patients who are obese

Next:

Medical Care

If the patient is able to retract the foreskin and does not have uncontrolled diabetes, he may be discharged to follow up with a urologist.

Circumcision should only be suggested, if the patient fails outpatient conservative therapy, particularly in children.

Patients should receive the following instructions:

  • Topical therapy - Bacitracin in children and clotrimazole in adults and possibly a steroid cream

  • Education - Improve personal hygiene by retracting the foreskin daily and cleaning the glans penis with water

 

Previous