NCBI Bookshelf. Anton A. Wray ; James Velasquez ; Shailesh Khetarpal. Authors Anton A. Wray 1 ; James Velasquez 2 ; Shailesh Khetarpal. Posthitis is an inflammation of the foreskin prepuce.
|Published (Last):||2 April 2011|
|PDF File Size:||18.93 Mb|
|ePub File Size:||8.66 Mb|
|Price:||Free* [*Free Regsitration Required]|
NCBI Bookshelf. Anton A. Wray ; James Velasquez ; Shailesh Khetarpal. Authors Anton A. Wray 1 ; James Velasquez 2 ; Shailesh Khetarpal. Posthitis is an inflammation of the foreskin prepuce. Balanoposthitis occurs only in uncircumcised males. Balanitis is not a sexually transmitted infection. Recurrent episodes of balanoposthitis should raise the concern for occult diabetes. The warm moist environment under the uncircumcised penile foreskin favors the growth of organisms that cause balanitis such as Fungi.
Fungal infections are the most common identifiable etiology with the majority of infections being caused by Candida albicans. The yeast can cause infection in certain cicumstances, especially when the patient has underlying conditions, poor hygiene, overgrowth, or changes in basline pH. Although yest infection is the most common cause, there are several other etiologies that exist and must be considered by the provider.
These include the following infectious and noninfectious etiologies . Balanitis can occur at any age. It affects approximately 1 in every 25 boys and 1 in 30 uncircumcised males during their life. Boys under 4 years of age and uncircumcised men are the highest risk group. When boys reach approximately the age of 5 years, the foreskin becomes easy to retract, and the risk of balanitis falls. The data suggest that circumcision prevents or protects against common infective penile dermatoses.
Balanitis is most common in uncircumcised males due to poor hygiene and the accumulation of smegma beneath the foreskin. Smegma is a whitish sebaceous secretion composed epithelial cells dead skin and the sebum oily secretions produced by the sebaceous glands of both male and female genitalia. Poor hygiene, a tight foreskin, and a buildup of smegma serve as a nidus for bacterial and fungal overgrowth which can lead to irritation and inflammation.
Fungal infections are usually responsible, most commonly involving the yeast Candida albicans. History and physical examination findings sometimes point to other etiologies that have management implications.
It may warrant specialty referral to a dermatologist for a biopsy or urologist. Localized edema may develop if someone allows balanitis to progress without treatment. The combination of inflammation and edema can cause adherence of the foreskin to the glans. Symptoms include pain, redness and a foul-smelling discharge from under the foreskin.
Balanitis has a more fulminant clinical presentation in diabetic and immunocompromised patients. Persistent inflammation and edema may cause scarring and adherence of the foreskin to the glans. Paraphimosis refers to trapping of the foreskin behind the glans penis and requires urgent reduction. Balanitis is a visual diagnosis, the clinical presentation and appearance of the lesions guide the diagnosis.
Additional evaluation may be warranted based upon the history and physical findings. Physical examination revealing an inflamed and erythematous glans confirms the diagnosis of balanitis. Certain features on clinical examination e. The initial aim of diagnosis and management should be to exclude STI, minimize problems with urinary and sexual function, and mitigate the risk of cancer of the penis. In cases of more severe inflammation, the addition of fluconazole mg stat orally or the combination of a topical imidazole and a low potency topical steroids such as hydrocortisone 0.
Treatment with a first-generation cephalosporin is appropriate if there is a concern for concomitant cellulitis. Causes of balanitis include Candida spp. Usually affects middle-aged to older uncircumcised men.
A biopsy can show pustules in the upper epidermis, similar in appearance to pustular psoriasis. There may also be a serpiginous annular dermatitis that often has a grayish white granular appearance with a "geographical" white margin.
If circinate balanitis is suspected clinically in a patient without known reactive arthritis, screening for STIs and testing for human leukocyte antigen HLA -B27 is advised. Pseudoepitheliomatous keratotic and micaceous balanitis : A condition characterized by scaly, wart-like skin lesions on the head of the penis. Phimosis is an abnormal constriction of the opening in the foreskin that precludes retraction over the glans penis, results from chronic inflammation and edema of the foreskin.
Development of phimosis often complicates sexual function, voiding, and hygiene. If the patient or medical staff forcibly retract the foreskin, paraphimosis trapping of the foreskin can occur. Phimosis is treatable in the emergent setting by dilation using a surgical clamp and pain medication.
In the event this is not successful, a dorsal slit circumcision can be performed by a urologist to temporize the problem. Definitive treatment, under elective circumstances, is complete circumcision. Paraphimosis refers to the trapping of the foreskin behind the glans penis and is a urologic emergency. The constricting foreskin has become located proximal to the glans penis. Under these circumstances, the constricting band will limit the venous and lymphatic outflow while allowing continued arterial inflow.
Over the course of minutes to hours, the glans will increase in size and become exquisitely painful and must undergo treatment by a urologist with reduction of the paraphimosis. To access free multiple choice questions on this topic, click here. This book is distributed under the terms of the Creative Commons Attribution 4. Turn recording back on. National Center for Biotechnology Information , U.
StatPearls [Internet]. Search term. Balanitis Anton A. Author Information Authors Anton A. Affiliations 1 Wyckoff Heights Medical Center. These include the following infectious and noninfectious etiologies  Infectious etiologies: Candidal species most commonly associated with diabetes. Chemical irritants e. Edematous conditions, including congestive heart failure right-sided , cirrhosis, and nephrosis.
Epidemiology Balanitis can occur at any age. Risk Factors Balanitis: Presence of foreskin. Diabetes particularly males with uncontrolled diabetes , probably due to Glucose on the skin, encouraging bacterial and fungal growth. Pathophysiology Balanitis is most common in uncircumcised males due to poor hygiene and the accumulation of smegma beneath the foreskin. Epithelial changes such as squamous hyperplasia and ulceration have an association with inflammation.
Evaluation Balanitis is a visual diagnosis, the clinical presentation and appearance of the lesions guide the diagnosis. Examples can include: Lichen planus, a skin pathology with small, itchy, pink, or purple spots on the arms or legs. Eczema, a chronic or long-term dermal condition that can result in itchy, reddened, cracked, and dry skin. The most common cause of balanitis is related to inadequate personal hygiene in uncircumcised males. Of cases with identifiable causes, candidal infection is the most common.
Various other infectious agents, dermatologic conditions, and premalignant conditions have associations with balanitis. Careful inspection for possible paraphimosis is necessary. History and physical examination findings sometimes point to specific etiologies that have management implications. Management of balanitis without an identifiable cause initially focuses on the implementation of local hygiene measures.
Retraction of the foreskin with thorough genital cleansing can be both preventive and therapeutic. The suggestion is twice-daily bathing of the affected area with a saline solution. Questions To access free multiple choice questions on this topic, click here.
Figure Balanitis. Contributed by DermNetNZ. References 1. Edwards S. Balanitis and balanoposthitis: a review. Genitourin Med. Vohra S, Badlani G.
Balanitis and balanoposthitis. North Am. Infectious balanoposthitis: management, clinical and laboratory features. Autodigestion of the glans penis and urethra by activated transplant pancreatic exocrine enzymes. Int J Prev Med. Choe JM. Paraphimosis: current treatment options. Am Fam Physician. Glob Health Sci Pract.
VVC usually is caused by C. Typical symptoms of VVC include pruritus, vaginal soreness, dyspareunia, external dysuria, and abnormal vaginal discharge. None of these symptoms is specific for VVC. On the basis of clinical presentation, microbiology, host factors, and response to therapy, VVC can be classified as either uncomplicated or complicated Box 3.