Highlights & Basics
- Balanoposthitis refers to inflammation of the glans penis and prepuce. It is a descriptive term and not a diagnosis.
- There are numerous causes; these can be broadly divided into inflammatory, infective, and precancerous.
- The aim of diagnosis and management should be to exclude STI, mitigate sexual and urinary dysfunction, and reduce the risk of cancer of the penis.
- A specific causative condition should be identified and treated effectively. Nonspecific balanoposthitis is a diagnosis of exclusion.
- Patients will typically present in a primary care setting. Input from specialists, particularly dermatologists and urologists, may be very helpful in the management of poorly responsive or complex cases.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Citations
Edwards SK, Bunker CB, van der Snoek EM, et al. 2022 European guideline for the management of balanoposthitis. J Eur Acad Dermatol Venereol. 2023 Jun;37(6):1104-17.[Abstract][Full Text]
Bunker CB, Watchorn RE. Dermatoses of the male genitalia. In: Griffiths C, Barker J, Bleiker T, et al. Rook's textbook of dermatology. 10th ed. Oxford: Wiley; 2024 (in press).
Lewis FM, Tatnall FM, Velangi SS, et al. British Association of Dermatologists guidelines for the management of lichen sclerosus 2018. Br J Dermatol 2018;178:839-53.[Full Text]
Centers for Disease Control and Prevention. Sexually transmitted infections treatment guidelines. Jul 2021 [internet publication].[Full Text]
1. Edwards SK, Bunker CB, van der Snoek EM, et al. 2022 European guideline for the management of balanoposthitis. J Eur Acad Dermatol Venereol. 2023 Jun;37(6):1104-17.[Abstract][Full Text]
2. Wakatsuki A. Clinical experience of streptococcal balanoposthitis in 47 healthy adult males. Hinyokika Kiyo. 2005;51:737-740.[Abstract]
3. Ramam M, Khaitan BK, Singh MK, et al. Frictional sweat dermatitis. Contact Dermatitis. 1998;38:49.[Abstract]
4. Jacobson MA. Review of the toxicities of foscarnet. J Acquir Immune Defic Syndr. 1992;5:11-17.[Abstract]
5. Birley HDL, Walker MM, Luzzi GA, et al. Clinical features and management of recurrent balanitis; association with atopy and genital washing. Genitourin Med. 1993;69:400-403.[Abstract][Full Text]
6. Reiter H. Ueber eine bisher unerkannte. Dtsch Med Woschensch. 1916;42:1535-1536.
7. Ridley CM. Lichen sclerosus et atrophicus. Br Med J (Clin Res Ed). 1987;295:1295-1296.[Abstract][Full Text]
8. Meffert JJ, Davis BM, Grimwood. Lichen sclerosus. J Am Acad Dermatol. 1995;32:393-416.[Abstract]
9. Powell JJ, Wojnarowska F. Lichen sclerosus. Lancet. 1999;22:1777-1783.[Abstract]
10. Bunker CB, Patel N, Shim TN. Urinary voiding symptomatology (micro-incontinence) in male genital lichen sclerosus. Acta Derm Venereol. 2013;93:246-8.[Full Text]
11. Bunker CB, Watchorn RE. Dermatoses of the male genitalia. In: Griffiths C, Barker J, Bleiker T, et al. Rook's textbook of dermatology. 10th ed. Oxford: Wiley; 2024 (in press).
12. Edmonds EV, Hunt S, Hawkins D, et al. Clinical parameters in male genital lichen sclerosus: a case series of 329 patients. J Eur Acad Dermatol Venereol. 2012;26:730-7.[Abstract]
13. Kravvas G, Shim TN, Doiron PR, et al. The diagnosis and management of male genital lichen sclerosus: a retrospective review of 301 patients. J Eur Acad Dermatol Venereol. 2018;32(1):91-5. [Abstract][Full Text]
14. Lewis FM, Tatnall FM, Velangi SS, et al. British Association of Dermatologists guidelines for the management of lichen sclerosus 2018. Br J Dermatol 2018;178:839-53.[Full Text]
15. Watchorn RE, van den Munckhof EHA, Quint KD, et al. Balanopreputial sac and urine microbiota in patients with male genital lichen sclerosus. Int J Dermatol. 2021 Feb;60(2):201-7.[Abstract]
16. Kravvas G, Muneer A, Watchorn RE, et al. Male genital lichen sclerosus, microincontinence and occlusion: mapping the disease across the prepuce. Clin Exp Dermatol. 2022 Jun;47(6):1124-30.[Abstract]
17. Edmonds E, Barton G, Buisson S, et al. Gene expression profiling in male genital lichen sclerosus. Int J Exp Pathol. 2011;92:320-5.[Abstract]
18. Altmeyer P, Kastner U, Luther H. Balanitis/balanoposthitis chronica circumscripta benigna plasmacellularis - entity or fiction? Hautarzt. 1998;49:552-5.[Abstract]
19. Bunker CB. Review of dermatology journals. Sex Transm Infect. 1999;75:281-2.
20. Yoganathan S, Bohl TG, Mason G. Plasma cell balanitis and vulvitis (of Zoon). J Reprod Med. 1994;39:939-44.[Abstract]
21. Kiene P, Folster-Holst R. No evidence of human papillomavirus infection in balanitis circumscripta plasmacellularis Zoon. Acta Derm Venereol. 1995;75:496-7.[Abstract]
22. Bunker CB. Zoon balanitis-does it exist? J Eur Acad Dermatol Venereol. 2020 Mar;34(3):e116-7.
23. Catterall RD. In: Winner HL, Hurley R, eds. Symposium on candida infections. Edinburgh, UK: Livingstone; 1966:113.
24. Odds FC. Genital candidiasis. Clin Exp Dermatol. 1982;7:345-354.[Abstract]
25. Kravvas G, Ge L, Ng J, et al. The management of penile intraepithelial neoplasia (PeIN): clinical and histological features and treatment of 345 patients and a review of the literature. J Dermatolog Treat. 2022 Mar;33(2):1047-62.[Abstract]
26. Kristiansen S, Svensson Å, Drevin L, et al. Risk Factors for penile intraepithelial neoplasia: a population-based register study in Sweden, 2000-2012. Acta Derm Venereol. 2019 Mar 1;99(3):315-20.[Abstract][Full Text]
27. Spencer A, Watchorn RE, Kravvas G, et al. Pseudoepitheliomatous keratotic and micaceous balanitis: a series of eight cases. J Eur Acad Dermatol Venereol. 2022 Oct;36(10):1851-6.[Abstract]
28. Tønne B, Ingvaldsen CA, Stubhaug V, et al. Balanoposthitis. [in nor]. Tidsskr Nor Laegeforen. 2023 Nov 6;143(16).[Abstract][Full Text]
29. Patrizi A, Costa AM, Fiorillo L, et al. Perianal streptococcal dermatitis associated with guttate psoriasis and/or balanoposthitis: a study of five cases. Pediatr Dermatol. 1994 Jun;11(2):168-71.[Abstract]
30. Horner PJ, Taylor-Robinson D. Association of mycoplasma genitalium with balanoposthitis in men with non-gonococcal urethritis. Sex Transm Infect. 2011 Feb;87(1):38-40.[Abstract]
31. Lee Y, Lee YM, Kim MJ, et al. Penile Crohn's disease resolved by infliximab. J Crohns Colitis. 2013 May;7(4):e146-9.[Abstract][Full Text]
32. Gatto-Weis C, Topolsky D, Sloane B, et al. Ulcerative balanoposthitis of the foreskin as a manifestation of chronic lymphocytic leukemia: case report and review of the literature. Urology. 2000 Oct 1;56(4):669.[Abstract]
33. Morris BJ, Krieger JN. Penile inflammatory skin disorders and the preventive role of circumcision. Int J Prev Med. 2017;8:32. [Abstract]
34. Mallon E, Hawkins D, Dinneen M, et al. Circumcision and genital dermatoses. Arch Dermatol. 2000;136:350-4.[Abstract][Full Text]
35. Olesen TB, Sand FL, Rasmussen CL, et al. Prevalence of human papillomavirus DNA and p16<sup>INK4a</sup> in penile cancer and penile intraepithelial neoplasia: a systematic review and meta-analysis. Lancet Oncol. 2019 Jan;20(1):145-58.[Abstract]
36. Doiron PR, Bunker CB. Expanding the benefits of HPV vaccination to boys and men. Lancet. 2016 Aug 13;388(10045):659.[Full Text]
37. UK Health Security Agency. Human papillomavirus (HPV): the green book, chapter 18a. Mar 2022 [internet publication].[Full Text]
38. Doiron PR, Bunker CB. Obesity-related male genital lichen sclerosus. J Eur Acad Dermatol Venereol. 2017;31(5):876-9.[Abstract][Full Text]
39. Chan S, Watchorn RE, Muneer A, et al. Lichen sclerosus following genital piercing. Int J STD AIDS. 2022 Apr;33(5):522-4.[Abstract]
40. Panou E, Panagou E, Foley C, et al. Male genital lichen sclerosus associated with urological interventions and microincontinence: a case series of 21 patients. Clin Exp Dermatol. 2022 Jan;47(1):107-9.[Abstract]
41. Rao A, Bunker CB. Male genital skin biopsy. Int J STD AIDS. 2011;22:418-419.[Abstract]
42. Chan SL, Watchorn RE, Panagou E, et al. Dermatoscopic findings of penile intraepithelial neoplasia: bowenoid papulosis, bowen disease and erythroplasia of Queyrat. Australas J Dermatol. 2019 Aug;60(3):e201-7.[Abstract]
43. Navarrete J, Cabrera R, Bunker CB, et al. Dermoscopy of penile sclerosing granuloma. BMJ Case Rep. 2021 Mar 2;14(3):e239846.[Abstract][Full Text]
44. Lacarrubba F, Borghi A, Verzì AE, et al. Dermoscopy of genital diseases: a review. J Eur Acad Dermatol Venereol. 2020 Oct;34(10):2198-207.[Abstract]
45. Bunker CB, Shim TN. Male genital lichen sclerosus. Indian J Dermatol. 2015;60:111-117.[Abstract][Full Text]
46. Bauer A, Geier J, Elsner P. Allergic contact dermatitis in patients with anogenital complaints. J Repro Med. 2000;45:649-654.[Abstract]
47. Pelisse M. Lichen sclerosus. Ann Dermatol Venereol. 1987;114:411-9.
48. Feldmann R, Harms M. Lichen sclerosus et atrophicus. Hautarzt. 1991 Mar;42:147-53.[Abstract]
49. Datta C, Dutta SK, Chaudhuri A. Histopathological and immunological studies in a cohort of balanitis xerotica obliterans. J Indian Med Assoc. 1993 Jun;91(6):146-8.[Abstract]
50. Bunker CB. Topics in penile dermatology. Clin Exp Dermatol. 2001;26:469-79.[Abstract]
51. Bunker CB. Re: Sanjay Kulkarni, Guido Barbagli, Deepak Kirpekar, et al. Lichen sclerosus of the male genitalia and urethra: surgical options and results in a multicenter international experience with 215 patients. Eur Urol 2009;55:945-56. Eur Urol. 2010 Dec;58(6):e55-6.
52. Centers for Disease Control and Prevention. Sexually transmitted infections treatment guidelines. Jul 2021 [internet publication].[Full Text]
53. World Health Organization. WHO guidelines for the treatment of Neisseria gonorrhoeae. Jan 2016 [internet publication].[Full Text]
54. Fifer H, Saunders J, Soni S, et al. 2018 UK national guideline for the management of infection with Neisseria gonorrhoeae. Int J STD AIDS. 2020 Jan;31(1):4-15.[Abstract][Full Text]
55. Bunker CB, Neill S, Staughton RC. Topical tacrolimus, genital lichen sclerosus, and risk of squamous cell carcinoma. Arch Dermatol. 2004;140:1169.[Abstract]
56. Bunker CB. Male genital lichen sclerosus and tacrolimus. Br J Dermatol. 2007;157:1079-1080.[Abstract]
57. Kidd LC, Chaing S, Chipollini J et al. Relationship between human papillomavirus and penile cancer--implications for prevention and treatment. Transl Androl Urol. 2017; 6(5): 791-802. [Abstract]
