Balanoposthitis

Last reviewed: 24 Aug 2022
Last updated: 18 Jun 2021

Summary

Definition

History and exam

Key diagnostic factors

  • uncircumcised state
More key diagnostic factors

Other diagnostic factors

  • multiple sexual partners
  • 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
Other diagnostic factors

Risk factors

  • congenital or acquired dysfunctional foreskin
  • uncircumcised state
  • poor hygiene; urinary dribbling or leakage
  • overwashing
  • human papillomavirus (HPV) infection
  • inflammatory skin diseases
More risk factors

Diagnostic investigations

1st investigations to order

  • swab for microbiology (Gram stain and culture) and PCR
  • swab for virology
  • dark-field microscopy
More 1st investigations to order

Investigations to consider

  • skin biopsy
  • patch testing
More investigations to consider

Emerging tests

  • dermoscopy

Treatment algorithm

ACUTE

atopic eczema

seborrheic dermatitis

irritant contact dermatitis

allergic contact dermatitis

psoriasis

reactive arthritis (Reiter disease)

lichen sclerosus

gonorrhea

candidosis

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 Bunker, MA, MD, FRCP

Consultant Dermatologist

Honorary Professor of Dermatology

University College London

Chelsea & Westminster Hospitals

London

UK

Disclosures

CB is the owner and CEO of Bruce Shrink Ltd., the publisher of Male Genital Skin Disease, an e-book authored by CB. CB lecturers frequently on balanoposthitis, is in receipt of grants to research the topic, and occasionally provides expert testimony on the topic. He is an author of a number of references cited in this topic.

Peer reviewers

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.

Jashin Wu, MD

Chief Dermatology Resident

University of California

Irvine

CA

Disclosures

JW declares that he has no competing interests.

Christopher Huston, MD

Assistant Professor of Medicine

Division of Infectious Diseases

University of Vermont College of Medicine

Burlington

VT

Disclosures

CH declares that he has no competing interests.

Nanette Silverberg, MD

Clinical Professor of Dermatology

Columbia University College of Physicians and Surgeons

New York City

NY

Disclosures

NS declares that she has no competing interests.

Julian Trevino, MD

Associate Professor of Dermatology and Dermatology Residency Program Director

Boonshoft School of Medicine

Wright State University

Dayton

OH

Disclosures

Speaker's Bureau, Stiefel; Consultant, Abbott.

  • Differentials

    • Eczema and dermatitis
    • Atopic dermatitis
    • Seborrheic dermatitis
    More Differentials
  • Guidelines

    • British Association of Dermatologists guidelines for the management of lichen sclerosus
    • Sexually transmitted diseases treatment guidelines, 2015
    More Guidelines
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