Balanitis

• Balanitis is the inflammation of the glans penis alone
• Posthitis is inflammation of the foreskin alone. 
• Balanoposthitis occurs only in uncircumcised males.

• Balanoposthitis Pre-pubertal
  • most often a mild irritant contact dermatitis
  • Chemical irritation: urine trapping, soiled nappies, soap residue
  • Physical trauma: forcible retraction
  • Candida nappy rash in infants
  • Treatment:
    • Soaking in warm salt water settles swelling and discomfort
    • Barrier or 1% hydrocortisone cream
    • Antifungal cream (clotrimazole, miconazole) if candida suspected
    • Oral analgesia may be needed
    • Topical antibiotic ointments and creams are not efficacious
    • Preputial retraction during acute inflammation should not be recommended as this can lead to paraphimosis
  • Severe balanoposthitis – glans penis is weeping and raw, pain during urination
    • caused by a Streptococcus pyogenes (group A streptococcus) infection. 
    • rash may also involve the perianal skin
    • need Abx cover

Balanoposthitis in adult males

• is usually caused by a dermatosis
  • Psoriasis
  • lichen planus
  • fixed drug eruptions
  • cutaneous malignancies
• presents as itchy, red, scaly maculopapular lesions on the glans penis, and erythema and erosion of the foreskin. 
• Take a swab for microscopy and culture to confirm infection –  the swab may require gentle retraction of foreskin to obtain an adequate sample
• If C. albicans is identified, treat with a combination of topical imidazole and hydrocortisone.
  • Use: hydrocortisone+clotrimazole 1%+1% cream topically, twice daily until the skin is clear and symptoms have resolved
• Advise – always retract the foreskin when washing
• rarely caused by Streptococcus pyogenes infection