Successful Management of Zoon’s Balanitis with Topical Mupirocin Ointment: A Case Report and Literature Review of Mupirocin-Responsive Balanitis Circumscripta Plasmacelluaris

Abstract

IntroductionZoon’s balanitis, also referred to as balanitis circumscripta plasmacellularis (BCP), is an idiopathic, benign inflammatory condition of the glans penis and foreskin most often seen in elderly uncircumcised men. A patient with a biopsy-confirmed diagnosis of BCP who was successfully treated with topical mupirocin ointment is described.MethodsThe PubMed database was searched with the key words: bactroban, balanitis, cell, circumscripta, mupirocin, plasma, plasmacellularis, tacrolimus, Zoon. The papers generated by the search and their references were reviewed.ResultsTreatments for BCP have previously included circumcision and topical calcineurin inhibitors. Our patient with BCP rapidly resolved after initiating treatment with mupirocin 2% ointment.ConclusionBCP is a benign dermatosis affecting the glans penis and foreskin. We confirm an earlier observation demonstrating successful management of this condition with topical mupirocin 2% ointment. Previously reported therapies include circumcision, topical calcineurin inhibitors, phototherapy, and laser therapy. However, based on our observations, topical mupirocin 2% ointment therapy may be considered for the initial management of patients with suspected BCP. Prompt response to mupirocin 2% ointment is highly suggestive of the diagnosis of BCP since morphologically similar skin conditions do not respond to this treatment.

Balanitis circumscripta plasmacellularis Zoon

“…Die BPZ ist eine chronisch-entzündliche Dermatose an der Glans penis und am Präputium, die meist ältere heterosexuelle Männer im Alter zwischen 40 und 80 betrifft, selten auch Jüngere oder Kinder [4,11,12]. Typisch sind scharf begrenzte, rot glänzende Erytheme, noduläre oder erosive Anteile können dazukommen [3,8].…”

“…Besonders angeschuldigt wird Mycobacterium smegmatis, das evtl. eine unspezifische polyklonale Stimulation von B-Zellen induziert [3,4].…”

“…Lokale Therapien umfassen Fusidinsäure [18], Antimykotika, Steroide und Calcineurin-Inhibitoren, die alle vorübergehend bei einer Anzahl von Fällen wirkten [3,4]…”

“…Die BPZ ist selten, sie betrifft bevorzugt ältere Männer mit einem Durchschnittsalter von 54,7 [3] bzw. 64,8 Jahren [4]. Die meisten Betroffenen sind nicht zirkumzidiert, oft mit Phimose und meist heterosexuell.…”

Topical cyclosporine 5% cream in Zoon's balanitis resistant to other therapies: A case report

“…Topical mupirocin 2% could be first line of therapy but relapse is frequent after suspension. 3,4 Topical corticosteroids are useful to treat the acute phase of ZB but they cannot be employed for a long period of time because of the local side effects.…”