Balanitis= التهاب الحشفة |
Balanitis
Balanitis is inflammation of the glans penis.1 Balanitis involving the foreskin and prepuce is termed balanoposthitis. Though uncommon, a complication of balanitis (usually only in recurrent cases) is constricting phimosis, or inability to retract the foreskin from the glans penis.
PathophysiologyUncircumcised men with poor personal hygiene are most affected by balanitis. Lack of aeration and irritation because of smegma and discharge surrounding the glans penis causes inflammation and edema. Though uncommon, complications of balanitis include phimosis and cellulitis. Meatal stenosis with urinary retention may rarely accompany balanitis. In very few cases, balanitis may contribute to the "buried penis syndrome
HistoryPatients with balanitis usually present with the following complaints:
PhysicalPhysical examination findings may include the following:
Causes
Laboratory studies for uncomplicated balanitis are not typically necessary but may include the following, when clinically appropriate:
Imaging Studies
Other Tests
Emergency Department Care
Consultations
MedicationThe goal of balanitis therapy is to eradicate infection and prevent complications. Antimicrobial agents (topical)Therapy must cover all likely pathogens in the context of the clinical setting. Clotrimazole (Mycelex, Lotrimin)Broad-spectrum antifungal agent that inhibits yeast growth by altering cell membrane permeability. For adult use, especially those with a positive history of candidiasis in a sexual partner.
AdultApply sparingly over affected area tid Pediatric<3 years: Not established
None reported
Documented hypersensitivity
PregnancyB - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals PrecautionsFor external use only; avoid contact with eyes; if irritation or sensitivity develops, discontinue use and institute appropriate therapy
Bacitracin (AK-Tracin)Prevents transfer of mucopeptides into growing cell wall, which inhibits cell wall synthesis and bacterial growth. More commonly used in pediatric patients or patients who are not sexually active.
AdultApply sparingly over affected area tid PediatricApply as in adults
None reported
Documented hypersensitivity
PregnancyC - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus PrecautionsProlonged use may result in overgrowth of nonsusceptible organisms Corticosteroids, topicalThese agents have anti-inflammatory properties and cause profound and varied metabolic effects. Corticosteroids modify the body's immune response to diverse stimuli. Betamethasone 0.05% (Alphatrex, Diprolene, Maxivate)For treatment of inflammatory dermatoses responsive to steroids. Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing capillary permeability. Affects production of lymphokines and has inhibitory effect on Langerhans cells.
AdultApply as thin film bid PediatricApply as in adults
None reported
Documented hypersensitivity; paronychia; cellulitis; impetigo; angular cheilitis; erythrasma; erysipelas; rosacea; perioral dermatitis; acne
PregnancyC - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus PrecautionsDo not use in skin with decreased circulation; can cause atrophy of groin, face, and axillae; may cause striae distensae, rosacealike eruption; may increase skin fragility; rarely may suppress HPA axis; if infection develops and is not responsive to antibiotic treatment, discontinue until infection is under control; do not use monotherapy to treat widespread plaque psoriasis Immunosuppressant agentsRegulates key factors responsible for the immune response. Pimecrolimus (Elidel cream)First nonsteroid cream approved in the US for mild-to-moderate atopic dermatitis. Derived from azcomycin, a natural substance produced by fungus Streptomyces hygroscopics var. ascomycetous. Selectively inhibits production and release of inflammatory cytokines from activated T-cells by binding to cytosolic immunophilin receptor macrophilin-12. The resulting complex inhibits phosphatase calcineurin, thus blocking T-cell activation and cytokine release. Cutaneous atrophy was not observed in clinical trials, a potential advantage over topical corticosteroids. Indicated only after other treatment options have failed.
AdultApply topically to penis bid; short-term and intermittent use only PediatricNot established
None reported
Documented hypersensitivity
PregnancyC - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus PrecautionsPotential exacerbation of existing infection at site of application; may cause burning and irritation; caution with conditions that suppress the immune system (eg, AIDS, cancer); possible risk of lymph node or skin cancer based on animal studies and a small number of patients; may increase risk of viral infections; other adverse effects include headache, sore throat, flulike symptoms, fever, and cough
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