Age of onset – Which patient groups are more prone to present balanitis or balanoposthitis more often?
The skin disease also presents seasonal exacerbation during the summer months. More often, however, it affects patients with diabetes mellitus or autoimmune diseases such as rheumatoid arthritis, local penile diseases, for e.g., phimosis, as well as patients receiving immunosuppressive drugs.
This condition is most often caused by a yeast (mainly the Candida albicans; the condition is then termed “Balanitits candida – Balanoposthitis”) or a bacterium (aerobic or anaerobic bacteria, e.g., Streptococci spp, Staphylococcus aureus, Ureaplasma spp, Gardnerella vaginalis, Trichomonas vaginalis).Sexually transmitted diseases (STDs).
Various sexually transmitted diseases such as genital warts, genital herpes, chlamydia and gonorrhea may trigger symptoms of Balanitis – Balanoposthitis.Various types of eczema (allergic, toxic/irritant, seborrheic). As the skin of the glans is highly sensitive it can react to certain chemical substances contained in cleansers, creams and even condoms or topical lubricants leading to severe irritation, which would result in the development of allergic or toxic dermatitis at the site. Uncontrolled diabetes mellitus (high levels of glucose in urine). These patients are at increased risk because glucose promotes the growth of bacteria and fungi on the skin. Moreover, at increased risk are those patients who are under medical treatment for diabetes (e.g., dapagliflozin) that causes increased elimination of sugar in urine. Chronic skin conditions.
Some skin diseases, such as psoriasis, lichen sclerosis et atrophicus or lichen planus and syphilis can create the conditions for the secondary manifestation of the disease.Less frequent causes of Balanitis:
i. “Circular Balanitis” (Reiter syndrome)
ii. “Balanitis plasmacellularis or Zoon’s Balanitis”
iii. “Erythroplasia Queyrat” (from HPV)
Once the doctor excludes all other possible diseases, he will seek the causes of the symptoms and then he will administer the right treatment. In difficult cases, in order to achieve a definite diagnosis, the physician will proceed to perform the following tests:
i. A sample from the glans area will be obtained for culture, in order to isolate the bacterium that causes the infection.
ii. Blood tests will be carried out to exclude other conditions.
iii. Screening will be performed to exclude diabetes mellitus.
iv. Collection of blood sample when symptoms persist despite treatment administration (Rare).
In rare cases, when the severity of symptoms is high, the administration of systemic treatment is mandatory, i.e., oral administration of medication. Finally, the Dermatologist will also recommend some general Balanitis – Balanoposthitis management instructions, which include the use of suitable hypoallergenic products for daily personal hygiene and cleansing of the genital area. Instructions for the prevention of disease relapse would also be offered.
If conditions, such as uncontrolled diabetes mellitus or phimosis, co-exist, these should be treated.