2022 European guideline for the management of balanoposthitis

Abstract

Background This guideline is an update to the 2014 edition of the European guideline for the management of balanoposthitis. Balanoposthitis describes inflammation of the glans penis and prepuce and is caused by a range of disparate conditions including infection, dermatoses and premalignancy. Objective The main objectives of this guideline are to aid recognition of the symptoms and signs and complications of penile skin conditions and to offer recommendations on the diagnostic tests and treatment for a selected group of these conditions. Methods The previous guideline was updated following a literature review and priority was given to randomized controlled trial and systematic review evidence. Results The updated guideline includes amended management for infective balanitis to provide clear guidance for Group A streptococcal infections, management of on going Lichen sclerosus (to include circumcision and supportive management to reduce the recurrence of genital herpes and warts), additional regimens for Zoonoid change, use of calcineurin inhibitors in management and risk of premalignancy and change of nomenclaturefrom Premalignant conditions to Penile Intraepithelial neoplasia (PeIN). Conclusion Balanoposthitis has a widerange of causes high quality evidence specific to the management of penile disease is not available for all the conditions described.

Erosive balanitis caused by Staphylococcus haemolyticus in a healthy, circumcised adult male

“…Yeast infections are the main causes of acute balanoposthitis, especially Candida albicans . The most common causes of bacterial balanoposthitis are streptococci groups B and D, and staphylococci, mainly Staphylococcus aureus [ 3 ]. In many studies, all patients were uncircumcised [ 1, 2 ].…”

“…Infectious balanoposthitis is the most frequent of the acute conditions. Candida infections are the most common cause of infectious balanoposthitis and aerobic bacteria are the second most common cause [ 3 ]. Other non-infectious causes can be traumatic, irritative or contact-based.…”

Progress in Dermatology and Venereology in 2023 as reflected in the Journal of the European Academy of Dermatology and Venereology

“…The European guideline for the management of balanoposthitis appeared this year with clear recommendations on the therapy of the various diseases underlying this condition. Apart from pharmacotherapeutic also general recommendations to management are given 18 …”

Treatment of plasma cell balanitis associated with male genital lichen sclerosus using abrocitinib

“…Plasma cell balanitis (PCB) is a rare benign skin disease characterized by a shiny and well-defined reddish patch on the glans penis. 1 Male genital lichen sclerosus (MGLS) is characterized by atrophic ivory plaques, and some scholars link it to autoimmunity. 2 Both PCB and MGLS can arise from redundant prepuce and exposure to chronic irritation such as prolonged urine infiltration, making their simultaneous occurrence in a patient possible.…”

“… 3 Treatments for PCB include calcineurin inhibitors, steroid ointments, and circumcision. 1 However, achieving a definitive treatment approach that fully satisfies patients with PCB associated with MGLS remains a complex and unmet clinical need. 3 …”