Can Balanitis Cause Sores?
Yes, balanitis can definitely cause sores, erosions, and ulcerations on the glans penis, depending on the underlying cause and severity of inflammation. 1, 2
Types of Sores Associated with Balanitis
Infectious Balanitis
- Candidal balanitis typically presents with erythematous areas accompanied by pruritus or irritation, and can progress to erosions in more severe cases 1, 2
- Bacterial infections, including anaerobic bacteria, can cause inflammatory lesions and erosions in the anogenital region 3
- Viral infections (particularly HSV and HPV) can cause distinct ulcerative lesions and chronic erosive balanitis 4
Inflammatory/Autoimmune Balanitis
- Lichen sclerosus (balanitis xerotica obliterans) can cause erosions, fissures, and painful ulcerations as part of its scarring process 5, 2
- The British Association of Dermatology guidelines specifically note that lichen sclerosus may present with "areas of ecchymosis" and that "pain may be a consequence of erosions or fissures" 5
- Lichen planus can characteristically lead to erosive inflammatory conditions of the glans penis 3
Drug-Induced Lesions
- Minocycline (when used for acne treatment) can cause "lesions occurring on the glans penis" that result in balanitis 5
- These drug-induced lesions can include erosions and ulcerations as part of hypersensitivity reactions 5
Clinical Significance and Red Flags
Any persistent, fixed, indurated, or ulcerated lesion requires biopsy to rule out malignant transformation, particularly in cases of chronic lichen sclerosus which carries a 2-9% risk of progression to squamous cell carcinoma 2, 6
When to Biopsy
- Pigmented, indurated, fixed, or ulcerated lesions mandate tissue diagnosis 2
- Persistent areas of hyperkeratosis, erosion, or erythema that fail to respond to adequate treatment require histological examination 5
- Any chronic or suspicious lesion must be rapidly assessed by biopsy to avoid missing pre-malignant conditions 6
Important Clinical Pitfall
The clinical appearance of balanitis is often non-specific and of little value in predicting the infectious agent or underlying cause 7. Do not assume all erosions or sores are simply candidal without appropriate diagnostic testing, as viral infections (HSV, HPV), bacterial causes, and inflammatory conditions like lichen sclerosus can all present with similar ulcerative features but require completely different management strategies 3, 7, 4.