Balanoposthitis - The International Union against Sexually ...

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Edwards. Management of balanoposthitis 71ERYTHROPLASIA OF QUEYRATDiagnosisClinical. Typical appearance: red, velvety, well-circumscribedarea on the glans. May have raisedwhite areas, but if indurated suggests franksquamous cell carcinoma.Laboratory. Biopsy: essential Ð squamous carcinoma insitu.ManagementIndications for therapy. Presence of lesion.Recommended regimen. Surgical excision: local excision is usuallyadequate and effective 12 .Alternative regimens. Fluorouracil cream 5% 13. Laser resection} 11 . Cryotherapy 14Management of partnersNot required.EquivalentFollow upObligatory because of the possibility of recurrence.Minimum of annual appointments.Auditable outcome measureOne hundred per cent of patients should have abiopsy.CIRCINATE BALANITISDiagnosisClinical. Typical appearance: greyish-white areas on theglans which coalesce to form `geographical'areas with a white margin. It may beassociated with other features of Reiter'ssyndrome but can occur without.Laboratory. Biopsy: spongiform pustules in the upperepidermis, similar to pustular psoriasis. Screening for STIs especially C. trachomatis.ManagementIndications for therapy. Symptomatic balanitis.Recommended regimen. Hydrocortisone cream 1% or occasionallymore potent topical steroids) for symptomaticbalanitis 9. Treatment of any underlying infection.Management of partnersIf an STI is diagnosed the partners) should betreated as per the appropriate protocol.Follow upRequired if persistent symptoms and/or associatedSTI.FIXED DRUG ERUPTIONSDiagnosisClinical. Typical appearance: variable but lesions areusually well-demarcated and erythematous,but can be bullous with subsequent ulceration. History: a careful drug history is essential, as isa history of previous reactions. Commonprecipitants include tetracyclines, salicylates,phenacetin, phenolphthalein and some hypnotics. Examine the oral and ocular mucosa. Rechallenge: this can con®rm the diagnosis.ManagementIndications for therapy. Symptomatic lesions.Recommended regimen. Topical steroids, e.g. 1% hydrocortisoneapplied twice a day until resolution 15 .Alternative regimen. Systemic steroids may be required if thelesions are severe.Management of partnersNot required.Follow upNot required after resolution. Patients should beadvised to avoid the precipitant.IRRITANT/ALLERGIC BALANITIDESDiagnosisClinical. Typical appearance: very variable. Appearancesrange from mild erythema to widespreadoedema of the penis
72 International Journal of STD & AIDS Volume 12 Supplement 3 October 2001. History: symptoms have been associated witha history of atopy or more frequent genitalwashing with soap. In a very small number ofcases a history of a precipitant may beobtained. Patch tests: useful in the small minority inwhom true allergy is suspected.Laboratory. Biopsy: may show non-speci®c in¯ammation.ManagementIndications for therapy. Symptomatic balanoposthitis.Recommended regimen. Avoidance of precipitants, especially soaps 16. Emollients Ð aqueous cream: applied asrequired and used as a soap substitute 15. Hydrocortisone 1% applied once or twice aday until resolution of symptoms.All the above should be used in combination.Management of partnersNot required.Follow upNot required, although recurrent problems arecommon and the patients need to be informed ofthis.References1 Edwards S. Balanitis and balanoposthitis: a review. GenitourinMed 1996;72:155±92 Schellhammer PF, Jordan GH, Robey EL, Spaulding JT.Premalignant lesions and nonsquamous malignancy of thepenis and carcinoma of the scrotum. Urol Clin North Am1992;19:131±423 Waugh MA, Evans EGV, Nayyar KC, Fong R. ClotrimazoleCanesten) in the treatment of candidal balanitis in men. BrJ Vener Dis 1978;54:184±64 Carrilo-Munoz AJ, Tur C, Torres J. In-vitro antifungalactivity of sertaconazole, bifonazole, ketoconazole andmiconazole against yeasts of the Candida genus. J AntimicrobialChemother 1996;37:815±195 Kinghorn GR, Woolley PD. Single-dose ¯uconazole in thetreatment of Candida albicans balanoposthitis. Int J STDAIDS 1990;1:366±76 Ewart Cree G, Willis AT, Phillips KD, Brazier JS. Anaerobicbalanoposthitis. BMJ 1982;284:859±607 Poynter JH, Levy J. Balanitis xerotica obliterans: Effectivetreatment with topical and sublesional steroids. Br J Urol1967;39:4208 Bernstein G, Forgaard DM, Miller JE. Carcinoma in situ ofthe glans and distal urethra. J Dermatol Surg Oncol 1986;12:4509 Oates JK. Dermatoses, balanoposthitis, vulvitis, BehcËet'ssyndrome and Peyronie's disease. In: Csonka GW, Oates JK,eds. Sexually Transmitted Diseases: ATextbook of GenitourinaryMedicine. London: BaillieÁre Tindall, 199010 Kumar B, Sharma R, Ragagopalan M, Radothra BD. Plasmacell balanitis: Clinical and histological features Ð responseto circumcision. Genitourin Med 1995;71:32±411 Boon TA. Sapphire probe laser surgery for localisedcarcinoma of the penis. Eur J Surg Oncol 1988;14:19312 Mikhail GR. Cancers, precancers and pseudocancers onthe male genitalia: A review of clinical appearances,histopathology, and management. J Dermatol Surg Oncol1980;6:102713 Goette DK, Elgart M, De Villez RL. Erythroplasia ofQueyrat: treatment with topically applied ¯uorouracil.JAMA 1975;232:93414 Sonnex TS, Ralfs IG, Delanza MP, et al. Treatment oferythroplasia of Queyrat with liquid nitrogen cryosurgery.Br J Dermatol 1982;106:581±415 Braun-Falco O, Plewig G, Wolff HH, Winkelman RK, eds.Dermatology. Berlin: Springer-Verlag, 1991:55316 Birley HDL, Walker MM, Luzzi GA, et al. Clinical featuresand management of recurrent balanitis: association withatopy and genital washing. Genitourin Med 1993;69:400±3
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