Balanitis plasmacellularis N48.1

Zoon 1950

Chronic, circumscribed, focal erosive inflammation of glans penis and/or inner preputial leaf of unknown cause, occurring exclusively in non-circumcised men. S.a.u. Vulvitis chronica circumscripta plasmacellularis.

Unexplained; possibly irritative-toxic (urinary incontinence; increase in concentration of urine in the foreskin environment with reduced smegma production in old age). Hygiene deficiencies?

Predominantly occurring in older men (> 60 years), rarely in men between 30-50 years. The disease does not occur in circumcised men.

One or more, circumscribed, sharply or blurredly defined, lacquer-like shiny, deep red to brownish-red, erosive plaques, often with petechial haemorrhages, which are called "cayenne pepper spots". Occasionally, the lesions may be contact-reactive as "kissing lesions".

Remarkable is only a slight clinical symptomatology with slight burning, itching or dysuria.

Epidermis atrophically flattened with absent horny and granular cell layer. Edema of the stratum papillare, dilatation of the capillaries in the upper corium, partial erythrocyte extravasations; hemosiderin deposits; band-shaped diffuse lymphohistiocytic infiltrate (also eosinophilic and neutrophilic granulocytes) with varying density of plasma cells (>50%). Remark: The occurrence of plasma cells is not a specific feature of balanitis "plasmacellularis", but is to be understood as a site-typical inflammatory reaction of the mucosa.

PIN (histology is diagnostic): circumscribed, red plaque, sharply demarcated.

Candida infections of the glans penis: mostly blurred, recurrent course.

Bakerial infections (children and adolescents): usually acute course, microbiological evidence of bacilli (frequently strepto- or staphylococci)

Cleanliness balanitis (triggered by excessive hygienic measures): blurred, extensive erythema

Mechanical irritation due to sexual practices: usually combined with cracks, erosions and fresh hemorrhages. Medical history.

s.a.under balanitis of other genesis

Observe general hygiene measures, see below. Balanitis candidamycetica. Daily hand-warm baths with addition of diluted potassium permanganate solution (light pink) or preparations containing tannin (e.g. Tannolact, Tannosynt).

Consistent "draining of the preputial space" by inserting a gauze gauze. Regular cleaning of the glans and foreskin with water or vegetable oils (e.g. olive oil), especially after urination to remove traces of urine. 2 times/day application of an ointment containing zinc (alternative: hydrophilic ointment not containing zinc). Subsequent treatment with active substance-free bases such as Ungt. emulsif. or wound-healing ointments, e.g. preparations containing cod liver oil (Desitin ointment or Mirfulan ointment).

In cases of severe local inflammatory symptoms, an ointment containing glucocorticoids can be applied for a short time under controlled conditions.

Alternative: Successful therapy with the calcineurin inhibitor tacrolimus has been reported (experimental approach!).

Circumcision is recommended for patients resistant to therapy and represents the gold standard in this constellation. Afterwards healing occurs in >80%.

Without circumcision, the disease progresses eminently chronically, chronically recurring, over months or even years, since hygiene errors cannot be avoided despite meticulous precautions. Malignancy (carcinoma in situ) must always be clarified.

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