Balanoposthitis by Aseem
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Balanoposthitis is inflammation of the glans penis and foreskin in uncircumcised males. It is commonly caused by infections, particularly Candida albicans or other fungi. Other causes include viruses like HSV, bacteria like Gardnerella vaginalis, irritants, trauma, fixed drug eruptions, premalignant conditions, and various cutaneous and mucocutaneous diseases. Symptoms include papules, pustules, vesicles, erosions, edema, phimosis, and foul discharge. Diagnosis involves examination, tests like KOH mounts or cultures, and biopsies. Treatment involves hygiene, antibiotics, antifungals, corticosteroids, circumcision for severe
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Balanoposthitis by Aseem
- 2. DEFINITION • Gk : ‘Balanos’ - Head of Penis / Glans Lat : ‘Posthe’ - Foreskin / Prepuce + ‘itis’ – inflammation Defined as the inflammation of the Glans Penis and mucosal surface of the Prepuce, commonly in uncircumcised males, with subpreputial discharge and phimosis. 2% Incidence
- 3. AETIOLOGY • INFECTIONS Fungal Candida albicans (MC – 20%) Malassezia furfur (P. orbiculare) Anaerobic Organisms Corynebacterium diphtheriae Fusospirochaetes
- 4. AETIOLOGY • INFECTIONS Spirochaetal Treponema Pallidum T. refrigens / phaegedenis / balanitidis / vincenti Viral HSV (20%) HPV Mycobacterial M. tuberculosis M. leprae
- 5. AETIOLOGY • INFECTIONS Aerobic Org Gardenella Vaginalis Streptococcus sp S. aureus Calymmatobacterium granulomatis Neisseria gonorrhoeae Chlamydia trachomatis Hemophilus ducreyi Pseudomonas
- 6. AETIOLOGY • INFECTIONS Protozoal Trichomonas vaginalis Entamoeba histolytica Parasitic Scabies Pediculosis Creeping eruptions / CLM
- 7. AETIOLOGY • IRRITANTS / ALLERGENS Smegma Soaps Urine Condoms Spermicides Podophyllin / Topicals Lubricants
- 8. AETIOLOGY • TRAUMATIC Post-coital / Post-masturbation Zip fastener laceration Frictional trauma Teeth bites Excoriations
- 9. AETIOLOGY • FIXED DRUG ERUPTIONS Tetracyclines / Sulphonamides Carbamazepines Dapsone Salicylates Erythromycin Metronidazole Barbiturates
- 10. AETIOLOGY PREMALIGNANT CONDITIONS Erythroplasia of Qeuyrat (Bowen’s dis) Leukoplakia Extramammary Paget’s MALIGNANT DISEASES SCC / BCC MELANOMAS
- 11. AETIOLOGY • CUTANEOUS / MUCOCUTANEOUS DIS Pemphigus DH / EM / SJS / TEN LP / Psoriasis Behcet’s Disease Aphthae Porokeratosis of Mibelli Herpes Zoster Varicella Zoster
- 12. AETIOLOGY • MISCELLANEOUS Circinate Balanitis Zoon’s Balanitis Balanitis Xerotica Obliterans (Lichen Sclerosus et Atrophicus) Pseudoepitheliomatous micaceous and keratotic balanitis of Civatte (PMKB) FB-induced (Beads / Calculi) Post Intravesical BCG (Granulomatous BP)
- 13. CLINICAL FEATURES • Papules / Pustules or Vesicles (even Bullae) with Erosions • Prepucial Edema, Phimosis • Thick, foul smelling subpreputial discharge • Pain / Pruritis / Burning Micturition • Painful LAN • Extensive Ulceration • Phaegedena
- 14. CLINICAL FEATURES • Frenal tears / Edema / Pain (Traumatic) • Vesicles / Bullae with Erosions (CD/FDE)
- 15. CLINICAL FEATURES • Smooth erythematous scaly papules with satellite pustules (Superadded inf)with peeling of skin +/- Plaques of thrush / Maceration / Erosions (Candida albicans)
- 16. CLINICAL FEATURES • Small Gray-White vesicles on erythematous base +/- Ulceration with Prostatitis / Urethritis (Trichomonas Vaginalis)
- 17. CLINICAL FEATURES • Superficial Erosions with Purulent Urethral Discharge (Neisseria Gonorrhoea)
- 18. CLINICAL FEATURES • Erosive indurated painless Chancre over Prepuce with Phimosis – Doughy inflitrate / Nodular Infiltrate / Diffuse Inflitrate) (Follman’s Balanitis of Syphilis)
- 19. CLINICAL FEATURES • Multiple painful shallow non-indurated ulcers with undermined edges over prepuce / glans +/- Phimosis (Chancroid)
- 20. CLINICAL FEATURES • Annular erythematous moist plaques with ulceration healing with fibrosis / scarring with preceding Oral Ulcers / Ophthalmic inv (Behcet’s Disease)
- 21. CLINICAL FEATURES • Bright red micaceous scaly annular plaques with cutaneous / nail / joint inv (Penile Psoriasis)
- 22. CLINICAL FEATURES • Painless, Serpiginous, geographic dermatitis of Glans (uncirc) and Hyperkeratotic plaques (Cir) (CIRCINATE BALANITIS of REITER’S DIS)
- 23. CLINICAL FEATURES • Chronic inflamm followed by atrophic sclerosis, depigmentation, induration, phimosi s and Urethral Stricture (Lichen Sclerosus et Atrophicans / BXO)
- 24. CLINICAL FEATURES • Chronic benign circumscribed plasma cell balanitis; shiny red velvety plaques with Cayenne Pepper stippling (ZB)
- 25. COMPLICATIONS • • • • • • • • • • Recurrence / Chronicity Phimosis / Paraphimosis BXO Prepucial Adhesions Prepucial Perforation Phagaedena Scarring / pigmentation Meatal Sricture Lymphedema Neoplasm
- 26. DIAGNOSIS • Detalied History taking / Clinical Examination • Confirm Diagnosis KOH MOUNT (CANDIDA) SUBPREPUTIAL SWAB for Culture (TRICH) GS / ZN STAIN (MIXED INF) PUS CULTURE / ABST (MIXED INF) DGI MICROSCOPY (SPIRO) TZANCK SMEAR (HSV) ACETOWHITE TEST (HPV) URETHRAL SWAB (GONO) PATCH TESTS (CD) SKIN BIOPSY
- 27. DIAGNOSIS • LAB INV (SPECIFIC) HIV VDRL / RPR / TPI / FTA-ABS BS F/PP URINALYSIS / CULTURE CBC
- 28. TREATMENT : GENERAL MEASURES SUBPREPUCIAL IRRIGATION NS / KMnO4 (1:10,000) / 1% Boric Acid 1% Lead Acetate / 0.6% MgSO4 CIRCUMCISION (Phimosis / ZB / Chronic / Intractable BP) TREATMENT OF SEXUAL PARTNER(S) MANAGEMENT OF SYSTEMIC DISEASE (HIV / DM / PSOR / BEHCET’S) PERSONAL HYGEINE
- 29. TREATMENT MEASURES : SPECIFIC • ORAL and / or TOPICAL ANTIBIOTICS / ANTIFUNGALS / ANTIVIRALS / ANTHELMINTHICS • TOPICAL CORTICOSTEROIDS (PSOR / LP / FDE / ZB / BXO / CD) • TOPICAL 5-FU 5% (PMKBoC / Bowen’s) • MOHS MICROSURGERY • SURGICAL MGMT (MEATOPLASTYTOMY, DORSAL SLIT, CIRCUMCISION)
- 30. THANK YOU