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Balanoposthitis

By Apollo 24|7, Published on- 23 November 2022 & Updated on -

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  • Symptoms: Pain and irritation on the foreskin and glans, oedema (itching), tenderness, swelling, shiny and white skin on the penis, leathery skin, Smegma under the foreskin, pain during urination and ejaculation, discolouration, sores, rashes, lesions on the head of the penis, foul smell.
  • Causes: poor hygiene, eczema, psoriasis, bacterial infections like Gonorrhoea, Scabies, Dermatitis, latex, lube or spermicide allergies, injuries, tight foreskin, reactive arthritis, irritation from chemical exposure or rubbing or scratching
  • Risk Factors: Diabetes, presence of foreskin, drug and chemical allergies, condom catheters, morbid obesity
  • Severity: Mild
  • Which doctor to consult: General Physician or a Urologist

Overview:

The inflammation of the glans, as well as the prepuce, is referred to as balanoposthitis. It is a descriptive phrase, not a diagnostic one. It is classified as a form of dermatosis that arises within the folds of the skin. Balanoposthitis cannot occur in a circumcised individual. However, balanitis or the inflammation of the glans can. Balanoposthitis may occur for a variety of reasons, which can be roughly categorised as inflammatory, infective, or precancerous.

Balanoposthitis may occur at any age and in anyone with an uncircumcised penis. It is not to be mistaken for balanitis or phimosis. Balanitis occurs when only the head of the penis swells due to inflammation, while phimosis makes it hard to retract the foreskin on the penis. Moreover, phimosis can be a symptom of both balanitis and balanoposthitis.

Typically penile yeast infections are the main cause of balanoposthitis. The fungus responsible for it is known as the candida fungus and is found in minimal quantities in the human body. Nevertheless, non-infectious diseases are also seen to cause balanoposthitis. These can include eczema, chronic balanitis, injuries, trauma, psoriasis and reactive arthritis.

Those with diabetes have a much higher chance of contracting the infection due to their weakened immune system. Moreover, obesity and inadequate glucose control may also put an individual at risk of a yeast infection and balanoposthitis. Inversely, frequent balanoposthitis may signal the possibility of type 2 diabetes in the individual.

However, it is curable and not fatal. Depending on the irritation one experiences, a general physician may suggest antibiotics, antifungal creams or corticosteroid creams. In addition, doctors recommend maintaining appropriate hygiene by washing and drying the foreskin and avoiding any allergens or irritants.

When to Consult a Doctor?

Some of the warning signs that should ideally require a doctor’s visitation for the same include:

  • Discolouration that resembles a rash. It might be red, purple, or a shade more profound than the natural skin tone.
  • Irritation and pain on the foreskin as well as the glans or head of the penis.
  • Itching
  • Lesions or sores on the glans or the head of the penis
  • Shiny or white patches on the skin of the penis
  • Swelling or oedema
  • Tenderness
  • The appearance of smegma, a foul-smelling secretion under the foreskin
  • The sensation of pain when urinating or ejaculating
  • Foul smell
  • Leathery skin

While balanoposthitis is not fatal or dangerous, it can cause immense pain and irritation. Hence, it is absolutely imperative to see a doctor for the condition. A general physician can help with the symptoms, and in severe cases, they may refer you to a urologist.

Diagnosis:

  • Physical Examination: Balanoposthitis is not necessarily a diagnosis. It is a descriptive term used to explain the symptom associated with another condition. The most basic procedure for detecting balanoposthitis is through a visit to a general physician or a urologist. They usually ask questions about the occurrence of symptoms. In addition, they enquire about the different health conditions that the individual may have.
  • Lab Tests: On completing an examination, a general physician may either prescribe medication or suggest lab tests. Some of these include skin tests, urethral discharge swab tests, urinalysis or blood tests.
  • Imaging Tests: In extremely serious cases, doctors may order a biopsy of the infected area to determine the source of the infection.

Treatment:

  • Home Care: Washing and drying the foreskin daily can help to avoid balanoposthitis. However, doctors often advise against using soaps and other possible irritants as one of the reasons for its occurrence is an underlying allergy.
  • Medication: The source of the inflammation determines the treatment for balanoposthitis. Often, simply treating the underlying problem relieves the symptoms. However, the cause of balanoposthitis is sometimes unclear. In these circumstances, treatments aim to reduce irritation during urination or intercourse. Antibiotic and antifungal lotions are commonly used as treatments. Doctors may administer corticosteroid creams as well.
  • Surgical Treatment: If balanoposthitis is too severe, i.e., if it does not respond to medicines, doctors may suggest a circumcision. However, this is also a minor surgery with very high success rates and minimal underlying issues.

Risks & Complications if Left Untreated

Patients experiencing recurrent or resistant symptoms to treatment beyond four weeks, as well as accompanying urinary blockage or pathologic phimosis, should be directed to a urologist. To further explore the cause, a biopsy can be deemed necessary.

Cancerous or precancerous lesions, such as Balanitis Xerotica Obliterans or squamous cell carcinoma, may be present in instances where the patient displays resistance to treatment. To achieve a pathologic diagnosis, a circumcision or even a 1 cm wedge biopsy of the affected region is necessary. Depending on the stage of infection, this may entail reconstructive surgery, radiation, or chemotherapy.

In immunocompromised individuals, balanoposthitis often manifests as a more serious ulcerating lesion. Only immunocompromised people who frequently have balanoposthitis due to a fungal infection are at risk of death.

Additional Information

Balanoposthitis can be of several types based on the origin of the infection. Some of them have been elaborated upon below:

  • Anaerobic Bacterial Infection: Erythema, oedema and discharge with a foul odour should raise suspicions of an anaerobic bacterial infection. In the case of these infections, milder cases can be managed using topical metronidazole. However, severe cases require oral antibiotics, such as oral metronidazole.
  • Bacterial Balanoposthitis: If there is significant erythema and preputial discharge that is either transudative or exudative, bacterial balanoposthitis is a massive possibility. Streptococcus pyogenes and Staphylococcus aureus are the two common aerobic bacteria.
  • Candidal Balanoposthitis: Candidal infection is a typical cause of balanoposthitis in young people, which can occur along with or as a result of diaper dermatitis. It is often described as an inflamed rash having satellite lesions that are painful to the touch. It can appear in adults with diabetes and immunosuppressive conditions. It can also appear in adults owing to the consumption of broad-spectrum antibiotics.
  • Fixed Drug Eruptions: Fixed drug eruptions are characterised by circular, erythematous patches that darken with or without oedema and vesicles. These occur with the use of pharmaceuticals such as tetracyclines, sulfa-drugs, phenolphthalein, phenacetin, NSAIDs, and barbiturates.
  • Irritant Balanoposthitis: Irritant balanoposthitis is often characterised by moderate erythema accompanied by or without pruritus. It is more frequent in people who have atopic dermatitis. This problem might be caused by excessive or frequent washing using soap.
  • Nonspecific Balanoposthitis: The most prevalent cause of balanoposthitis in children is nonspecific balanoposthitis. This condition is typically caused by improper hygiene. There shouldn't be any ulcers or lesions, and while one may detect some preputial discharge on a physical exam, no urethral drainage should be present.
  • Viral Balanoposthitis: Herpes simplex virus and human papillomavirus are examples of viral balanoposthitis. Herpes simplex is characterised by an erythematous base and overlaying vesicles which may rupture.
     

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Frequently Asked Questions

Balanitis causes only the penis glans to swell up due to inflammation. However, balanoposthitis causes both the glans and the prepuce or foreskin to swell up. Balanitis is usually a symptom of balanoposthitis, but not vice versa.

Balanoposthitis is usually not fatal. It is completely curable through antibiotics, antifungal and corticosteroid creams, as well as proper hygiene maintenance. Some slightly severe cases may require circumcision, a minor surgery.