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BALANOPOSTHITIS
DEFINITION
• Gk : ‘Balanos’ - Head of Penis / Glans
Lat : ‘Posthe’ - Foreskin / Prepuce
+ ‘itis’ – inflammation
Defined as...
AETIOLOGY
• INFECTIONS
Fungal
Candida albicans (MC – 20%)
Malassezia furfur (P. orbiculare)
Anaerobic Organisms
Corynebact...
AETIOLOGY
• INFECTIONS
Spirochaetal
Treponema Pallidum
T. refrigens / phaegedenis / balanitidis /
vincenti
Viral
HSV (20%)...
AETIOLOGY
• INFECTIONS
Aerobic Org
Gardenella Vaginalis
Streptococcus sp
S. aureus
Calymmatobacterium granulomatis
Neisser...
AETIOLOGY
• INFECTIONS
Protozoal
Trichomonas vaginalis
Entamoeba histolytica
Parasitic
Scabies
Pediculosis
Creeping erupti...
AETIOLOGY
• IRRITANTS / ALLERGENS
Smegma
Soaps
Urine
Condoms
Spermicides
Podophyllin / Topicals
Lubricants
AETIOLOGY
• TRAUMATIC
Post-coital / Post-masturbation
Zip fastener laceration
Frictional trauma
Teeth bites
Excoriations
AETIOLOGY
• FIXED DRUG ERUPTIONS
Tetracyclines / Sulphonamides
Carbamazepines
Dapsone
Salicylates
Erythromycin
Metronidazo...
AETIOLOGY
PREMALIGNANT CONDITIONS
Erythroplasia of Qeuyrat (Bowen’s dis)
Leukoplakia
Extramammary Paget’s
MALIGNANT DISEAS...
AETIOLOGY
• CUTANEOUS / MUCOCUTANEOUS DIS
Pemphigus
DH / EM / SJS / TEN
LP / Psoriasis
Behcet’s Disease
Aphthae
Porokerato...
AETIOLOGY
• MISCELLANEOUS
Circinate Balanitis
Zoon’s Balanitis
Balanitis Xerotica Obliterans
(Lichen Sclerosus et Atrophic...
CLINICAL FEATURES
• Papules / Pustules or Vesicles (even Bullae)
with Erosions
• Prepucial Edema, Phimosis
• Thick, foul s...
CLINICAL FEATURES
• Frenal tears / Edema / Pain (Traumatic)

• Vesicles / Bullae with Erosions (CD/FDE)
CLINICAL FEATURES
• Smooth erythematous scaly papules with
satellite pustules (Superadded inf)with peeling
of skin +/- Pla...
CLINICAL FEATURES
• Small Gray-White vesicles on erythematous
base +/- Ulceration with Prostatitis / Urethritis
(Trichomon...
CLINICAL FEATURES
• Superficial Erosions with Purulent Urethral
Discharge (Neisseria Gonorrhoea)
CLINICAL FEATURES
• Erosive indurated painless Chancre over
Prepuce with Phimosis – Doughy inflitrate /
Nodular Infiltrate...
CLINICAL FEATURES
• Multiple painful shallow non-indurated ulcers
with undermined edges over prepuce / glans
+/- Phimosis ...
CLINICAL FEATURES
• Annular erythematous moist plaques with
ulceration healing with fibrosis / scarring with
preceding Ora...
CLINICAL FEATURES
• Bright red micaceous scaly annular plaques
with cutaneous / nail / joint inv
(Penile Psoriasis)
CLINICAL FEATURES
• Painless, Serpiginous, geographic dermatitis of
Glans (uncirc) and Hyperkeratotic plaques (Cir)
(CIRCI...
CLINICAL FEATURES
• Chronic inflamm followed by atrophic
sclerosis, depigmentation, induration, phimosi
s and Urethral Str...
CLINICAL FEATURES
• Chronic benign circumscribed plasma cell
balanitis; shiny red velvety plaques with
Cayenne Pepper stip...
COMPLICATIONS
•
•
•
•
•
•
•
•
•
•

Recurrence / Chronicity
Phimosis / Paraphimosis
BXO
Prepucial Adhesions
Prepucial Perfo...
DIAGNOSIS
• Detalied History taking / Clinical Examination

• Confirm Diagnosis
KOH MOUNT (CANDIDA)
SUBPREPUTIAL SWAB for ...
DIAGNOSIS
• LAB INV (SPECIFIC)
HIV
VDRL / RPR / TPI / FTA-ABS
BS F/PP
URINALYSIS / CULTURE
CBC
TREATMENT : GENERAL MEASURES
SUBPREPUCIAL IRRIGATION
NS / KMnO4 (1:10,000) / 1% Boric Acid
1% Lead Acetate / 0.6% MgSO4
CI...
TREATMENT MEASURES : SPECIFIC
• ORAL and / or TOPICAL ANTIBIOTICS /
ANTIFUNGALS / ANTIVIRALS /
ANTHELMINTHICS
• TOPICAL CO...
THANK YOU
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Balanoposthitis by Aseem

Short ppt on Balanoposthitis and how to reach a diagnosis of Non Specific Balanoposthitis by exclusion.

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Balanoposthitis by Aseem

  1. 1. BALANOPOSTHITIS
  2. 2. DEFINITION • Gk : ‘Balanos’ - Head of Penis / Glans Lat : ‘Posthe’ - Foreskin / Prepuce + ‘itis’ – inflammation Defined as the inflammation of the Glans Penis and mucosal surface of the Prepuce, commonly in uncircumcised males, with subpreputial discharge and phimosis. 2% Incidence
  3. 3. AETIOLOGY • INFECTIONS Fungal Candida albicans (MC – 20%) Malassezia furfur (P. orbiculare) Anaerobic Organisms Corynebacterium diphtheriae Fusospirochaetes
  4. 4. AETIOLOGY • INFECTIONS Spirochaetal Treponema Pallidum T. refrigens / phaegedenis / balanitidis / vincenti Viral HSV (20%) HPV Mycobacterial M. tuberculosis M. leprae
  5. 5. AETIOLOGY • INFECTIONS Aerobic Org Gardenella Vaginalis Streptococcus sp S. aureus Calymmatobacterium granulomatis Neisseria gonorrhoeae Chlamydia trachomatis Hemophilus ducreyi Pseudomonas
  6. 6. AETIOLOGY • INFECTIONS Protozoal Trichomonas vaginalis Entamoeba histolytica Parasitic Scabies Pediculosis Creeping eruptions / CLM
  7. 7. AETIOLOGY • IRRITANTS / ALLERGENS Smegma Soaps Urine Condoms Spermicides Podophyllin / Topicals Lubricants
  8. 8. AETIOLOGY • TRAUMATIC Post-coital / Post-masturbation Zip fastener laceration Frictional trauma Teeth bites Excoriations
  9. 9. AETIOLOGY • FIXED DRUG ERUPTIONS Tetracyclines / Sulphonamides Carbamazepines Dapsone Salicylates Erythromycin Metronidazole Barbiturates
  10. 10. AETIOLOGY PREMALIGNANT CONDITIONS Erythroplasia of Qeuyrat (Bowen’s dis) Leukoplakia Extramammary Paget’s MALIGNANT DISEASES SCC / BCC MELANOMAS
  11. 11. AETIOLOGY • CUTANEOUS / MUCOCUTANEOUS DIS Pemphigus DH / EM / SJS / TEN LP / Psoriasis Behcet’s Disease Aphthae Porokeratosis of Mibelli Herpes Zoster Varicella Zoster
  12. 12. AETIOLOGY • MISCELLANEOUS Circinate Balanitis Zoon’s Balanitis Balanitis Xerotica Obliterans (Lichen Sclerosus et Atrophicus) Pseudoepitheliomatous micaceous and keratotic balanitis of Civatte (PMKB) FB-induced (Beads / Calculi) Post Intravesical BCG (Granulomatous BP)
  13. 13. CLINICAL FEATURES • Papules / Pustules or Vesicles (even Bullae) with Erosions • Prepucial Edema, Phimosis • Thick, foul smelling subpreputial discharge • Pain / Pruritis / Burning Micturition • Painful LAN • Extensive Ulceration • Phaegedena
  14. 14. CLINICAL FEATURES • Frenal tears / Edema / Pain (Traumatic) • Vesicles / Bullae with Erosions (CD/FDE)
  15. 15. CLINICAL FEATURES • Smooth erythematous scaly papules with satellite pustules (Superadded inf)with peeling of skin +/- Plaques of thrush / Maceration / Erosions (Candida albicans)
  16. 16. CLINICAL FEATURES • Small Gray-White vesicles on erythematous base +/- Ulceration with Prostatitis / Urethritis (Trichomonas Vaginalis)
  17. 17. CLINICAL FEATURES • Superficial Erosions with Purulent Urethral Discharge (Neisseria Gonorrhoea)
  18. 18. CLINICAL FEATURES • Erosive indurated painless Chancre over Prepuce with Phimosis – Doughy inflitrate / Nodular Infiltrate / Diffuse Inflitrate) (Follman’s Balanitis of Syphilis)
  19. 19. CLINICAL FEATURES • Multiple painful shallow non-indurated ulcers with undermined edges over prepuce / glans +/- Phimosis (Chancroid)
  20. 20. CLINICAL FEATURES • Annular erythematous moist plaques with ulceration healing with fibrosis / scarring with preceding Oral Ulcers / Ophthalmic inv (Behcet’s Disease)
  21. 21. CLINICAL FEATURES • Bright red micaceous scaly annular plaques with cutaneous / nail / joint inv (Penile Psoriasis)
  22. 22. CLINICAL FEATURES • Painless, Serpiginous, geographic dermatitis of Glans (uncirc) and Hyperkeratotic plaques (Cir) (CIRCINATE BALANITIS of REITER’S DIS)
  23. 23. CLINICAL FEATURES • Chronic inflamm followed by atrophic sclerosis, depigmentation, induration, phimosi s and Urethral Stricture (Lichen Sclerosus et Atrophicans / BXO)
  24. 24. CLINICAL FEATURES • Chronic benign circumscribed plasma cell balanitis; shiny red velvety plaques with Cayenne Pepper stippling (ZB)
  25. 25. COMPLICATIONS • • • • • • • • • • Recurrence / Chronicity Phimosis / Paraphimosis BXO Prepucial Adhesions Prepucial Perforation Phagaedena Scarring / pigmentation Meatal Sricture Lymphedema Neoplasm
  26. 26. DIAGNOSIS • Detalied History taking / Clinical Examination • Confirm Diagnosis KOH MOUNT (CANDIDA) SUBPREPUTIAL SWAB for Culture (TRICH) GS / ZN STAIN (MIXED INF) PUS CULTURE / ABST (MIXED INF) DGI MICROSCOPY (SPIRO) TZANCK SMEAR (HSV) ACETOWHITE TEST (HPV) URETHRAL SWAB (GONO) PATCH TESTS (CD) SKIN BIOPSY
  27. 27. DIAGNOSIS • LAB INV (SPECIFIC) HIV VDRL / RPR / TPI / FTA-ABS BS F/PP URINALYSIS / CULTURE CBC
  28. 28. TREATMENT : GENERAL MEASURES SUBPREPUCIAL IRRIGATION NS / KMnO4 (1:10,000) / 1% Boric Acid 1% Lead Acetate / 0.6% MgSO4 CIRCUMCISION (Phimosis / ZB / Chronic / Intractable BP) TREATMENT OF SEXUAL PARTNER(S) MANAGEMENT OF SYSTEMIC DISEASE (HIV / DM / PSOR / BEHCET’S) PERSONAL HYGEINE
  29. 29. TREATMENT MEASURES : SPECIFIC • ORAL and / or TOPICAL ANTIBIOTICS / ANTIFUNGALS / ANTIVIRALS / ANTHELMINTHICS • TOPICAL CORTICOSTEROIDS (PSOR / LP / FDE / ZB / BXO / CD) • TOPICAL 5-FU 5% (PMKBoC / Bowen’s) • MOHS MICROSURGERY • SURGICAL MGMT (MEATOPLASTYTOMY, DORSAL SLIT, CIRCUMCISION)
  30. 30. THANK YOU

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