Balanitis (Balanoposthitis)

Balanitis is inflammation of the foreskin, which usually affects the glans penis and tissues behind the foreskin (balanoposthitis).

Causative factors

• Phimosis

• Poor hygiene

• Candida albicans infection; others including severe Streptococcus pyogenes

• Inflammatory dermatoses: e.g. lichen sclerosis, eczema

• Diabetes and HIV (predisposing)

Treatment

• Mild cases may be treated with gentle saline bathing, a barrier cream or hydrocortisone 1% to tip of penis, and then application of an antibacterial ointment, e.g. fucidin, if more severe

• Take swabs for culture if purulent discharge

• Careful washing behind foreskin

If yeasts present—topical nystatin or imidazole cream (e.g. clotrimazole 1% for 5 d)

If trichomonads present—metronidazole or tinidazole (oral treatment)

If bacteria present (usu. cellulitis)—appropriate topical antibiotic under foreskin (e.g. chloramphenicol or combination corticosteroid, antibacterial, antifungal); if severe, di(flu)cloxacillin (o) or IV

Thickening of the foreskin with skin pallor suggests balanitis xerotica obliterans, which may respond to corticosteroid cream if it is mild. Can result in phimosis, usually 10–12 yrs. Circumcision is indicated for recurrent problems.

Mild cases with phimosis in children Apply 0.05% betamethasone cream tds or combination ointment for 10 days.