Balanitis of Zoon

Abstract

Balanitis of Zoon is a relatively common diagnosis in elderly men, although its nature is controversial and descriptions of its histopathologic features in current textbooks of dermatopathology vary considerably. We studied 45 cases of balanitis of Zoon clinically and histopathologically. The earliest histopathologic changes in cases diagnosed clinically as balanitis of Zoon were slight thickening of the epidermis, parakeratosis, and a patchy lichenoid infiltrate of lymphocytes and some plasma cells. More advanced cases showed atrophy of the epidermis, superficial erosions, a scattering of neutrophils in the upper reaches of the epidermis, scant spongiosis, extravasation of erythrocytes, and a much denser infiltrate with many plasma cells. Additional findings at even later stages were subepidermal clefts, sometimes with loss of the entire epidermis, marked fibrosis of the superficial dermis, and many siderophages. That sequence of histopathologic changes is compatible with the thesis that balanitis of Zoon results from irritation or mild trauma affecting barely keratinized skin in a moist environment. As a reaction to nonspecific stimuli, balanitis of Zoon may be found superimposed on lesions of other diseases and may modify the histopathologic presentation of those diseases to the extent that they are no longer recognizable. In the current study, several cases diagnosed originally as balanitis of Zoon turned out to be examples of allergic contact dermatitis, psoriasis, lichen planus, and squamous cell carcinoma in situ. It is important, therefore, to recognize balanitis of Zoon as a nonspecific pattern that may occur either as an isolated finding or may complicate other diseases affecting the glans penis or prepuce of uncircumcised men.

Therapeutic Efficacy of Topical Calcineurin Inhibitors in Plasma Cell Balanitis: Case Series and Review of the Literature

“…Its exact cause remains unknown. PCBZ may occur either as an isolated finding or may coexist with or complicate other entities [12,13,14,15,16] that may be seen in the same patient at different time points or arise in the chronically inflamed mucosae of PCBZ [17]. Unlike some other inflammatory penile dermatoses, PCBZ is regarded as a benign condition and not considered to be a precursor for neoplasia [14].…”

“…Biopsy of the lesion is usually necessary to confirm the diagnosis and rule out other conditions that are considered in the differential diagnosis, such as fixed drug eruptions, seborrheic eczema, lichen planus, lichen sclerosus et atrophicus, cicatricial pemphigoid, penile intraepithelial neoplasia (erythroplasia of Queyrat), squamous cell carcinoma, Kaposi's sarcoma, contact dermatitis or psoriasis [7,16,20,21,22]. Histologically, epidermal edema, a dense upper dermal band of chronic inflammatory cells, including many plasma cells, dilated capillaries, extravasated red blood cells, and hemosiderin deposition, is observed [23].…”

“…PCBZ is better considered a reaction to nonspecific stimuli [16]. It has been suggested that PCBZ results from irritation or mild trauma affecting barely keratinized skin in a moist environment [16]; therefore, PCBZ should be characterized as a nonspecific pattern that may occur as an isolated finding or complicate other diseases of the genital area [16].…”

“…PCBZ is better considered a reaction to nonspecific stimuli [16]. It has been suggested that PCBZ results from irritation or mild trauma affecting barely keratinized skin in a moist environment [16]; therefore, PCBZ should be characterized as a nonspecific pattern that may occur as an isolated finding or complicate other diseases of the genital area [16]. It has also been supported that this condition is not a nonspecific inflammatory response but is related to immediate hypersensitivity, since IgE and IgG have been found in the plasma cellular infiltrate [26].…”

Review of 120 Biopsies Performed on the Balanopreputial Sac

“…The most recent histopathological study performed on this topic is the one published by Weyers et al in 2002 [6]. Reviewing a series of cases, these authors found a sequence in the evolution of lesions from a patchy lichenoid pattern to a dense plasmacytic infiltrate with possible prominent fibrosis in the latest stages.…”