Balanitis plasmacellularis

Balanitis plasmacellularis, also known as Zoon's balanitis, is a chronic condition affecting the glans penis and foreskin. It is characterized by a distinctive bright red or orange, shiny, and smooth appearance of the affected area. This condition was first described by Zoon in 1952, hence the name Zoon's balanitis. It is predominantly observed in uncircumcised, middle-aged to older men, although rare cases have been reported in circumcised individuals and females (vulvitis plasmacellularis).

Etiology and Pathogenesis

The exact cause of balanitis plasmacellularis remains unclear. However, it is believed to be a reaction to chronic irritation and inflammation rather than an infection. Factors such as poor hygiene, retained smegma, and chronic friction may contribute to its development. Histologically, the condition is marked by a dense infiltrate of plasma cells in the dermis, hence the name plasmacellularis.

Clinical Features

Patients with balanitis plasmacellularis typically present with persistent redness of the glans and foreskin, which may be accompanied by mild itching or discomfort. Unlike other forms of balanitis, it is not usually associated with discharge. The lesions are well-demarcated and can have a glazed, shiny appearance. Over time, the condition can lead to phimosis or difficulty retracting the foreskin due to scarring.

Diagnosis

Diagnosis of balanitis plasmacellularis is primarily clinical, based on the characteristic appearance of the lesions. A biopsy may be performed to confirm the diagnosis and rule out other conditions, such as squamous cell carcinoma, lichen sclerosus, and infectious causes of balanitis. Histopathology reveals a dense plasma cell infiltrate in the dermis with minimal epidermal changes.

Treatment

Treatment of balanitis plasmacellularis aims to reduce inflammation and alleviate symptoms. Options include improved hygiene, topical corticosteroids, and, in refractory cases, circumcision. Circumcision is considered curative as it removes the affected tissue and eliminates the environment conducive to chronic inflammation. Other treatments, such as topical calcineurin inhibitors, have been reported to be effective in some cases.

Prognosis

The prognosis for balanitis plasmacellularis is generally good with appropriate treatment. While the condition can be persistent and may require long-term management, serious complications are rare. Early diagnosis and treatment can prevent progression to phimosis and reduce the risk of secondary infection.

Epidemiology

Balanitis plasmacellularis is a relatively rare condition, with the exact prevalence unknown. It primarily affects uncircumcised middle-aged to older men but can occur at any age and in circumcised individuals.

See Also

• Balanitis
• Phimosis
• Circumcision
• Dermatitis