Can balanitis cause sores?

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 must also be considered as potential causes of ulcerative lesions 3

Inflammatory and Chronic Forms

• Lichen sclerosus (balanitis xerotica obliterans) commonly causes erosions and fissures as part of its scarring process, which can be painful and significantly impact quality of life 4, 2
• The porcelain-white plaques characteristic of lichen sclerosus are often associated with areas of ecchymosis (bruising), and erosions or fissures frequently develop 4
• Plasma-cell balanitis represents a distinct clinical entity that can present with erosive changes 5

Drug-Induced Lesions

• Minocycline (used for acne treatment) can cause lesions on the glans penis that result in balanitis, including fixed drug eruptions and erythema multiforme 4

Critical Diagnostic Considerations

Any persistent, fixed, indurated, pigmented, or ulcerated lesion requires biopsy to rule out malignant transformation, particularly in cases of lichen sclerosus which carries a 2-9% risk of progression to squamous cell carcinoma 2, 6

When to Biopsy

• Biopsy is mandatory if there is suspicion of neoplastic change, including persistent areas of hyperkeratosis, erosion, erythema, or new warty/papular lesions 4
• Any chronic or suspicious lesion must be rapidly assessed by biopsy, as lichen sclerosus may develop into squamous cell carcinoma requiring lifelong follow-up 6

Treatment Approach Based on Cause

For Candidal Balanitis with Erosions

• First-line: Miconazole 2% cream applied twice daily for 7 days, or tioconazole 6.5% ointment as a single application 1, 2
• For severe or resistant cases: Oral fluconazole 150 mg as a single dose 1, 2
• Proper genital hygiene is essential—gentle cleansing with warm water, avoiding strong soaps, and keeping the area dry 1, 2

For Lichen Sclerosus with Erosions

• Topical clobetasol propionate 0.05% cream twice daily for 2-3 months 2
• Severe cases with urethral involvement may require surgical management 2
• Long-term follow-up is mandatory due to malignancy risk 2, 6

Important Pitfalls to Avoid

• Do not assume all erosive balanitis is candidal—the clinical appearance has little value in predicting the infectious agent, and multiple causes including bacterial, viral, and inflammatory conditions must be considered 7, 3
• Do not use combination antifungal-corticosteroid preparations without a clear diagnosis, as steroids can worsen fungal infections 1
• Do not delay biopsy for persistent or atypical lesions, as early diagnosis of premalignant conditions is critical to prevent progression to squamous cell carcinoma 2, 6

Follow-Up Requirements

• Follow-up is recommended if symptoms persist or recur within 2 months 1, 2
• For recurrent episodes, consider further diagnostic evaluation including STI screening (Gram stain, NAAT for gonorrhea/chlamydia, syphilis serology, HIV testing) and evaluation for underlying conditions such as diabetes 2
• Immunocompromised patients require more aggressive evaluation due to higher risk for fungal and mycobacterial infections 2