Summary
Definition
History and exam
Key diagnostic factors
- uncircumcised state
Other diagnostic factors
- multiple sexual partners or high-risk sexual behaviors
- postinflammatory hypo- or hyperpigmentation
- pruritus
- red scaly patches
- erosions
- personal/family history of atopy (eczema, hay fever, asthma, type I allergies)
- personal/family history of psoriasis
- urinary dribbling
- hypopigmentation
- purpura
- red plaques
- blisters
- papules or micropapules
- pustules
Risk factors
- congenital or acquired dysfunctional foreskin
- uncircumcised state
- poor hygiene; urinary dribbling or leakage
- overwashing
- human papillomavirus (HPV) infection
- inflammatory skin diseases
Diagnostic tests
1st tests to order
- swab for microbiology (Gram stain and culture) and Nucleic acid amplification test (NAAT)
- swab for virology
- dark-field microscopy
Tests to consider
- skin biopsy
- patch testing
Emerging tests
- dermoscopy
Treatment algorithm
atopic eczema
seborrheic dermatitis
irritant contact dermatitis
allergic contact dermatitis
psoriasis
reactive arthritis (Reiter disease)
lichen sclerosus
gonorrhea
candidiasis
nonspecific balanoposthitis
Zoon balanitis
carcinoma in situ/penile intraepithelial neoplasia (PeIN)
Contributors
Authors
Ien Chan, MD, FRCP
Consultant Dermatologist
Chelsea and Westminster Hospital
London
UK
Disclosures
IC declares that he has no competing interests.
David Hawkins, FRCP
Consultant Genitourinary Physician
Chelsea and Westminster Hospital
London
UK
Disclosures
DH declares that he has no competing interests.
Christopher B. Bunker, MA, MD, FRCP
Consultant Dermatologist
Honorary Professor of Dermatology
University College London
Chelsea & Westminster Hospitals
London
UK
Disclosures
CBB is the owner and CEO of Bruce Shrink Ltd., the publisher of Male Genital Skin Disease, an e-book authored by CBB. He has done consultancy work for the British Skin Foundation. The fee for this work is usually paid to the British Skin Foundation. He is the honorary secretary of the British Skin Foundation, the senior Medical Trustee. CBB has provided advice to MC2, with a pipeline lichens sclerosis product, for which he has not received payment. CBB does a dedicated weekly male genital clinic at University College London Hospitals from which his employer receives income. CBB has a private practice and patients with male genital skin disorders consult him, for which he is remunerated. CBB is a frequent speaker at meetings on male genital dermatology (occasionally, his travel and accommodation are subsidised and he received honoraria) and is in receipt of a grant from a private donor, administered by the British Skin Foundation, to investigate the relationship of lichen sclerosus to penis cancer. He has been appointed to lead the 2024 reiterate of the British Association of Dermatology Guidelines on lichen sclerosus; he has previously been contributor. Occasionally, CBB provides expert advice medical litigation, for which he receives remuneration. He is an author of a number of references cited in this topic.
Peer reviewers
Jesse Mills, MD
Professor of Urology
Director of the Men's Clinic at UCLA
University of California Los Angeles
Los Angeles
CA
Disclosures
JM declares that he has no competing interests.
Colm O'Mahony, MD, FRCP, BSc, DIPVen
Consultant in Sexual Health
Department of Sexual Health
Countess of Chester Hospital NHS Foundation Trust
Chester
UK
Disclosures
CO declares that he has no competing interests.
Sarah Edwards, MD
Consultant
Department of GU Medicine
West Suffolk Hospital
Suffolk
UK
Disclosures
SE declares that she has no competing interests.
David Paige, MD
Consultant Dermatologist and Honorary Senior Lecturer
Dermatology Department
The Royal London Hospital
London
UK
Disclosures
DP declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
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.Full text Abstract
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
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Eczema and dermatitis
- Atopic dermatitis
- Seborrheic dermatitis
More DifferentialsGuidelines
- European guideline for the management of balanoposthitis
- European guideline for the management of balanoposthitis
More Guidelines
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