Plasma cell balanitis (Zoon`s balanitis): A clinicopathological study of 8 cases

Abstract

A disorder first described by Zoon in 1952, Zoon`s balanitis or Plasma cell balanitis (PCB), is an uncommon clinical disorder seen in middleaged uncircumcised men. It is characterized by one or more indolent well demarcated, glazed, reddish brown patches on the glans penis or prepuce. The etiology of this disease is unknown. This balanitis does not respond to routine topical antifungals, steroid creams and systemic antifungals. Diagnosis is confirmed by biopsy. Herein we report 8 cases of PCB, presenting with a characteristic clinical picture of the disease. In all cases circumcision was done and histopathology confirmed the diagnosis of PCB. All patients were followed up for a period of 6 months and no recurrences were observed. Development of malignancy is not seen. In conclusion. We believe that for all cases of balanitis, not responding to routine topical antifungals, steroid creams and systemic antifungals, the diagnosis of Zoon`s balanitis should be considered. StreszczenieChoroba po raz pierwszy została opisana przez Zoon`a w 1952 roku. Zapalenie żołędzi typu Zoona lub też plazmacytowe zapalenie żołędzi (PCB) jest rzadkim, klinicznym zaburzeniem obserwowanym u nieobrzezanych mężczyzn w średnim wieku. Charakteryzuje się ono jedną lub większą ilością łagodnych, dobrze odgraniczonych, połyskujących, czerwonawych plamek na żołędzi penisa lub napletku. Etiologia zmian pozostaje nieznana. Ten rodzaj zapalenia żołędzi nie odpowiada na typowe leczenie przeciwgrzybicze: miejscowe czy systemowe oraz na maści sterydowe. Diagnoza jest potwierdzana biopsją. W tym artykule opisujemy 8 przypadków PCB oraz ich obraz kliniczny. We wszystkich przypadkach został wykonany zabieg obrzezania a badanie histopatologiczne potwierdziło diagnozę. Wszyscy pacjenci byli obserwowani przez okres 6 miesięcy, nie zanotowano nawrotu choroby. Nie zanotowano transformacji nowotworowej. Wszystkie przypadki zapalenia żołędzi nie odpowiadające na leczenie przeciwgrzybicze miejscowe lub systemowe oraz na maści sterydowe powinny zostać ponownie rozpatrzone pod kątem diagnozy PCB.

Zoon's balanitis treated with topical tacrolimus

“…Plasma cell balanitis usually presents as solitary, shiny, and red-orange plaque on the glans or the prepuce in uncircumcised middle-aged or older man. [ 3 ] Though there has been mentioned about different variants such as vegetative, erosive, or multiple lesions variants in the literature,[ 4 ] it typically presents as solitary lesion. Plasma cell balanitis usually takes more indolent course with lesion developed months-years prior consultation.…”

“…Plasma cell balanitis usually takes more indolent course with lesion developed months-years prior consultation. [ 3 ] Symptoms are minimal and nonspecific such as pruritus or mild tenderness. [ 3 ] Diagnosis is confirmed by histopathological examination of lesion.…”

“…[ 3 ] Symptoms are minimal and nonspecific such as pruritus or mild tenderness. [ 3 ] Diagnosis is confirmed by histopathological examination of lesion. [ 5 ] Epidermal atrophy with complete effacement of rete pegs, sub-epidermal infiltrate of dense lichenoid material with predominant plasma cells are the hallmark of plasma cell balanitis.…”

“…Though the cause of plasma cell balanitis is unclear, many predisposing factors such as uncircumcised male, heat, poor hygiene, friction, trauma, hypospadias, and chronic infection with Mycobacterium smegmatis have been described. [ 3 ]…”

“…Circumcision has been treatment of choice for plasma cell balanitis. [ 3 8 9 ] Successful laser ablation has also been described. [ 10 ] Literature does not support use of topical agents for treatment of plasma cell balanitis as it claims that lesion usually recurs after discontinuation of treatment and topical treatment is not curative enough.…”