A patient, aged 65 years, presented with an asymptomatic eruption of his penis. He denied prior episode of a similar rash, recent sexual contact, commencement of any new medications, and history of skin disease.
Examination revealed shiny, well-demarcated erythematous patches of the corona and prepuce. No exudates or vesicles were apparent, and inguinal nodes were nonpapable.
The patient was treated with tacrolimus (Progaf) ointment 0.1% and econazole cream which resulted in resolution of the dermatitis on follow-up examination.
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The patient was diagnosed with a condition known as balanoposthitis, an inflammatory disorder involving the glans and prepuce. In addition to being uncircumcised, other predisposing factors for balanoposthitis include poor hygiene and irritation by smegma.
Balanoposthitis occurs more frequently in patients with underlying medical conditions such as diabetes mellitus and immunosuppression.1 Patients with this disorder will complain of nonspecific symptoms, such as burning and pruritis. They will typically present with erythema and papules with or without eroded satellite pustules.2
Balanoposthitis may be caused by infection, with the most common agent being Candida albicans.2 This may be diagnosed by KOH examination or fungal culture.
Other causes include bacterial and viral infections, most notably caused by Streptococcus spp. and human papilloma virus (HPV).2,3 Antifungals are the most common treatment for Candida balanoposthitis. Treatment of bacterial infections is based on the organism detected by culture. HPV-induced balanoposthitis may respond to podophyllotoxin.
Many other conditions can affect the glans and prepuce. Differential diagnoses include primary syphilis, contact dermatitis, fixed drug eruption, lichen planus, psoriasis, Bowen disease, and bowenoid papulosis.4
Topical therapies resulted in complete resolution of this patient’s dermatitis. If the condition had persisted, biopsy and culture would be considered for definitive diagnosis.
Megha D. Patel is a student at The Commonwealth Medical College in Scranton, Pennsylvania.
Stephen Schleicher, MD, is an associate professor of Medicine at the Commonwealth Medical College and an Adjunct Assistant Professor of Dermatology at the University of Pennsylvania Medical College. He practices dermatology in Hazleton, Pennsylvania.
- Edwards S. Genitourin Med. 1996; 72:155-159.
- Lisboa C,Ferreira A,Resende C,Rodrigues AG. International Journal of Dermatology. 2009; 48: 121-124.
- Edwards SK. Int J STD AIDS. 2001; 12(Suppl 3): 68-72.
- Edwards S, Bunker C, Ziller F, van der Meijden WI. Int J STD AIDS. 2014; 25(9): 615-626