From the Guidelines
Balanitis should be treated with topical antifungal agents to relieve symptoms, as recommended by the Centers for Disease Control and Prevention 1. The diagnosis of balanitis involves identifying the underlying cause, which can be fungal, bacterial, or irritant-induced.
Key Considerations
- For mild cases, treatment involves improved hygiene with gentle cleansing using warm water only (no soap) and thoroughly drying the area.
- Over-the-counter antifungal creams like clotrimazole 1% applied twice daily for 7-14 days are effective if the cause is fungal (Candida) 1.
- If bacterial infection is suspected, topical antibiotics such as mupirocin 2% ointment applied three times daily for 7-10 days may be prescribed.
Treatment Approach
- For severe or persistent cases, oral antifungals like fluconazole 150mg as a single dose or oral antibiotics such as cephalexin 500mg four times daily for 7 days might be necessary.
- During treatment, avoid sexual activity until symptoms resolve, keep the area dry, wear loose cotton underwear, and retract the foreskin during urination and bathing if uncircumcised.
- Balanitis often occurs due to poor hygiene, irritants, or underlying conditions like diabetes, so addressing these factors is crucial for prevention.
Follow-up and Prevention
- If symptoms don't improve within a week of treatment, or if they recur frequently, medical evaluation is necessary to rule out other conditions like sexually transmitted infections or penile cancer.
- Regular follow-up with a healthcare provider is essential to monitor the response to treatment and prevent complications.
- The British Association of Dermatologists guidelines for the management of lichen sclerosus, 2018, also emphasize the importance of follow-up and monitoring for disease recurrence 1.
From the Research
Diagnosis of Balanitis
- Balanitis is a descriptive diagnosis for a heterogeneous group of infectious or inflammatory dermatoses that have to be differentiated from malignant conditions 2
- The diagnosis of balanitis involves a complete skin examination and a thorough patient history with respect to topically applied products and sexual behavior 2
- The clinical aspect of balanitis is often non-specific, and laboratory procedures such as culture studies are necessary to confirm the diagnosis 3
Causes of Balanitis
- Balanitis can be caused by various microorganisms, including Candida spp., bacterial infections, viral infections, parasites, and other sexually transmitted infections (STI) 2, 3
- Irritant dermatitis is a common cause of recurrent balanitis, and is often associated with atopic illness and frequent genital washing with soap 4
- Lichen planus, psoriasis, and contact dermatitis can also characteristically lead to inflammatory conditions of the glans penis 2
Treatment of Balanitis
- Infections must be treated, and the glans penis should be kept dry to ensure a balanced genital hygiene in patients 2
- Antifungal agents are commonly used to treat infectious balanitis, and are effective in eradicating Candida albicans and other microorganisms 3, 5
- A single oral dose of fluconazole is comparable in efficacy and safety to topical clotrimazole cream applied for 7 days in the treatment of candidal balanitis 5
- Therapeutic circumcision can be considered as a last resort for most forms of chronic balanitis 2
- Biopsy is an important investigation in the diagnosis of balanitis, especially when the condition does not seem to be caused by irritant dermatitis 4