Zoon’s Balanitis: Diagnosis and Management. Well-defined, shiny, reddish-orange patch at the glans penis.

🔎 Introduction

Zoon’s balanitis, also known as plasma cell balanitis, is a chronic, benign inflammatory condition of the glans penis, typically seen in uncircumcised, middle-aged to elderly men.It is not sexually transmitted, but its appearance can mimic penile carcinoma in situ (erythroplasia of Queyrat), making accurate diagnosis essential.

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🧬 Pathophysiology

• Chronic irritation from retained smegma, moisture, and friction under the foreskin.

• Histology: dense plasma cell infiltrate in dermis, epidermal spongiosis, parakeratosis, and hemosiderin deposition.

• Chronic but non-malignant condition.
  

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👨‍⚕️ Clinical Features

• Site: Glans penis (may extend to inner foreskin).

• Lesion:

  • Single or multiple well-defined, shiny, reddish-orange patches.

  • “Lacquered” surface.

  • Characteristic cayenne pepper spots (punctate speckles due to hemosiderin).

• Symptoms:

  • Usually asymptomatic.

  • Occasionally, mild burning or irritation.

  • No ulceration, no scaling, no pain, no pruritus.
    

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🧪 Diagnosis

1. Clinical Examination

• Well-demarcated shiny erythematous patch on the glans in an uncircumcised man.
  

2. Investigations

• Biopsy (gold standard):

  • Essential to exclude erythroplasia of Queyrat (penile carcinoma in situ).

  • Findings: dense plasma cell infiltrate, epidermal thinning, and hemosiderin deposits.
    

3. Differential Diagnosis

• Zoon’s balanitis (plasma cell balanitis)

  • Chronic, reddish, shiny, well-demarcated patches on the glans.

  • Typically, painless, non-itchy, and seen in uncircumcised men.

• Erythroplasia of Queyrat (penile carcinoma in situ)

  • Velvety red plaque, usually painless.

  • Needs a biopsy to exclude malignancy.

• Candidal balanitis

  • Can present with erythematous patches/plaques, but usually associated with itching, burning, or whitish discharge.

• Lichen planus (genital)

  • Flat-topped violaceous or reddish lesions.

  • May be asymptomatic or mildly itchy.

• Fixed drug eruption

  • Recurrent red patches at the same site after drug exposure (e.g., NSAIDs, antibiotics).

  • Usually, sharply demarcated lesions.
    

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🏥 Management

1. Definitive Treatment

• Circumcision → curative ✅

  • Eliminates a moist environment under the foreskin.

  • Prevents recurrence.

  • Recommended by dermatology/urology guidelines.
    

2. Medical / Conservative Treatment

For patients refusing or awaiting circumcision:

• Topical corticosteroids (e.g., triamcinolone 0.1% cream, applied thinly once daily for 2–4 weeks).

  • ❌ Not for long-term use (risk of atrophy, recurrence common).

• Topical calcineurin inhibitors (preferred for long-term use):

  • Tacrolimus 0.03% ointment bid → safe for genital skin.

• Other options in refractory cases:

  • Imiquimod 5% cream.

  • Photodynamic therapy.

  • Carbon dioxide laser ablation.
    

3. Supportive Measures

• Gentle genital hygiene (avoid harsh soaps).

• Keep glans dry.

• Avoid irritants and trauma.

• Treat coexisting infections if present.
  

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🔁 Prognosis

• Chronic but benign.

• Medical therapy may induce remission, but has a high recurrence if the foreskin is retained.

• Circumcision is a definitive cure with negligible recurrence.
  

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📚 Key Exam Pearls

• ✅ Uncircumcised man + shiny red patch on glans + no pain/itch → Zoon’s balanitis.

• ✅ Biopsy required to rule out carcinoma in situ.

• ✅ Circumcision = definitive cure.

• ❌ Do not confuse with erythroplasia of Queyrat (precancerous).
  

⚡ Memory Tip: “Zoon is benign, Queyrat can kill.”

Would you like me to make a side-by-side exam table: Zoon’s balanitis vs. erythroplasia of Queyrat