From the Guidelines
Balanitis should be treated with topical antifungal agents for symptomatic relief, especially if caused by a fungal infection, 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 allergic in nature. Symptoms typically include redness, swelling, pain, and sometimes discharge on the glans penis.
Treatment Approach
- For mild cases, gentle cleansing with warm water (avoiding soap) and keeping the area dry is recommended.
- If caused by a fungal infection (candidal balanitis), applying an antifungal cream like clotrimazole 1% or miconazole 2% twice daily for 7-14 days is advised, as suggested by the treatment guidelines for sexually transmitted diseases 1.
- For bacterial infections, antibacterial creams such as fusidic acid or mupirocin may be prescribed, or oral antibiotics if severe.
- Steroid creams like hydrocortisone 1% can help reduce inflammation if allergic or irritant causes are suspected.
Management Considerations
- Uncircumcised men should retract the foreskin during washing and ensure thorough drying afterward to prevent moisture accumulation, which can exacerbate fungal infections.
- If diabetes is present, blood sugar control is essential as high glucose levels promote infections.
- Recurrent balanitis may indicate an underlying condition requiring further evaluation, such as lichen sclerosus, which has specific management guidelines including follow-up and potential surgical interventions 1.
- Seek medical attention if symptoms worsen or don't improve within a week of treatment, as persistent inflammation can lead to complications including phimosis (tight foreskin) or scarring.
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
- Balanitis can be caused by various factors, including Candida spp., bacterial infections, viral infections, parasites, and other sexually transmitted infections (STI) 2, 3
- Lichen planus, psoriasis, and contact dermatitis can also lead to inflammatory conditions of the glans penis 2
Treatment of Balanitis
- Infections must be treated, and the glans penis should be kept dry 2
- A balanced genital hygiene is essential in patients with balanitis 2
- Therapeutic circumcision can be considered as a last resort for most forms of chronic balanitis 2
- Antifungal agents are commonly used to treat infectious balanitis, with Candida albicans being a common cause 3, 4
- Topical clotrimazole and oral fluconazole are effective treatments for candidal balanitis, with fluconazole being comparable in efficacy and safety to clotrimazole cream 4
- Laser and surgical management can provide long-term remission for Zoon's balanitis, a chronic inflammatory disorder of the genital mucosa 5
Management of Specific Types of Balanitis
- Zoon's balanitis is a chronic inflammatory disorder that requires proper diagnosis and early management, with histopathological examination and dermoscopy being useful diagnostic tools 5
- Infectious balanitis can be caused by various microorganisms, including Staphylococcus spp. and groups B and D Streptococci, and requires appropriate antibiotic therapy 3