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DipGUM > Balanoposthitis > Flashcards

Balanoposthitis Flashcards

1
Q

What is balanoposthitis?

A

Balanitis - inflammation of glans penis

Posthitis - inflammation of prepuce (foreskin)

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2
Q

What proportion of GUM attendees present with balanoposthitis?

A

11%

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3
Q

Who is balanitis uncommon in?

A

Circumcised men

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4
Q

What are the symptoms of balanoposthitis?

A 
Local rash 
dyspareunia
Itch
Odour
Inability to retract foreskin
discharge from glans/behind foreskin
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5
Q

What other symptoms associated with balanoposthitis elsewhere on the body?

A 
Rash elsewhere
Sore mouth
JOint pains
Swollen/painful glands
general malaise
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6
Q

When describing changes to the genitals in balanoposthitis what might be present?

A 
COLOUR change
- erythema
- leukoplakia
- purpura
TEXTURAL change
- scaling
- sclerosis
- ulceration
- fissuring
- crusting
- exudate
- oedema
- odour
- phimosis
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7
Q

What complications may arise from balanoposthitis?

A

Phimosis
Meatal stenosis
Malignant transformation

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8
Q

What is a sub-preputial swab useful for in balanoposthitis?

A

To exclude infective cause/superinfection

  • candida
  • bacterial culture
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9
Q

When should urinalysis for glucose be performed in balanoposthitis?

A

Most cases

especially in candida suspected

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10
Q

What should initial assessment of ulcerative balanoposthitis include?

A

Swab of ulcer for HSV and treponema pallidum PCR +/- dark ground microscopy

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11
Q

What STI is most commonly associated with balanoposthitis?

A

Chlamydia trachomatis

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12
Q

What should be screened for in circinate-type balanitis?

A

STIs

Urethritis

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13
Q

When is biopsy indicated for balanoposthitis?

A

Diagnosis uncertain

Condition persists

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14
Q

Balanoposthitis - general advice

A

avoid soaps while inflammation

effect on condoms if cream treatment being applied

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15
Q

Balanoposthitis - describe step-wise/flow chart approach to balanoposthitis?

A 
Culture
Pathogen found - treat
No pathogen
- good hygiene - emollients and washing advice
- poor hygiene - salt washes and washing advice
No improvement
- hydrocortisone 1% BD 2weeks
then biopsy if no improvement
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16
Q

Candidal balanitis - symptoms & signs?

A

symptoms
- rash, soreness +/- itch
signs
- blotchy erythema with small papules eroded or dry dull red areas with glazed appearance

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17
Q

Candidal balanitis - treatment?

A 
Topical
-Clotrimazole 2%
-miconazole 2%
Oral (if severe)
-fluconazole 10mg STAT
marked inflammation
-Add topical hydrocortisone
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18
Q

Anaerobic balanitis - symptoms & signs?

A

symptoms
- foul smelling, swelling, inflamed glans
signs
- preputial oedema, superficial erosion, inguinal adenitis

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19
Q

What investigation should be performed I ulceration in anaerobic balanitis?

A

Swab for HSV

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20
Q

Anaerobic balanitis - treatment?

A

Metronidazole 400mg BD 7 days
or
co-amoxiclav 375mg 3 times daily 7 days

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21
Q

Aerobic balanitis - clinical features?

A

non-specific balanitis

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22
Q

Organism implicated in aerobic balanitis?

A

Streptococcal group A
Staphylococcus aureus
Gardnerella vaginalis

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23
Q

What are other causes of non-specific balanitis?

A

HSV
TV
syphilis

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24
Q

Lichen sclerosus aka balanitis xerotica obliterans (BXO) - aetiology?

A

inflammatory skin condition

autoimmune pathogenesis

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25
Q

Who gets balanitis xerotica obliterans (lichen sclerosus)?

A

ALL ages

12.1% of preputial surgical cases in paediatrics

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26
Q

Lichen sclerosus aka balanitis xerotica obliterans (BXO) - symptoms and signs?

A 
symptoms
- itching, soreness, splitting, haemorrhagic blisters, dyspareunia, problems with urination
signs
- white patches on glans +/- prepuce
- haemorrhagic vesicles, purpura
ARCHITECTURAL changes
- blunting of coronal sulcus
- phimosis
- wasting of prepuce
- meatal thickening and narrowing
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27
Q

Lichen sclerosus aka balanitis xerotica obliterans (BXO) - complications?

A

Phimosis
Urethral stenosis
Malignant transformation

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28
Q

What proportion of penile cancer has histological changes of lichen sclerosus?

A

28%

29
Q

Where is extra-genital disease common in men with lichen sclerosis?

A

Perianal disease

30
Q

Lichen sclerosus aka balanitis xerotica obliterans (BXO) - biopsy?

A

LAYERS

1) thickened epidermis to atrophic with follicular hyperkeratosis
2) band of dermal hyalinisation with loss of elastin fibres
3) perivascular lymphocytic infiltration

31
Q

Lichen sclerosus - treatment?

A

Topical/initial
-POTENT topical steroid DAILY until remission then reduce
-may require INTERMITTENT
Surgical
-CIRCUMCISION if phimosis
-surgical management of urethral stenosis

32
Q

Balanitis xerotica obliterans (BXO) - follow up?

A

Dependent on case

At least annually in case of malignant transformation

33
Q

Zoon’s (plasma cell) balanitis - aetiology?

A

disease of older men
typically uncircumcised
irritation partially from urine within a ‘dysfunctional prepuce’

34
Q

Zoon’s (plasma cell) balanitis - clinical appearance?

A 
variable
well circumscribed
orange-red glazed areas
glans
AND
multiple pin point redder spots 'cayenne pepper spots'
35
Q

Zoon’s (plasma cell) balanitis - investigation?

A

Early biopsy

36
Q

Zoon’s (plasma cell) balanitis - treatment?

A

Circumcision
Topical steroids
Hygiene measures

37
Q

Psoriasis balanitis - clinical appearance?

A 
Circumcised
- similar to psoriasis elsewhere on body
- red scaly plaques
Uncircumcised
- scaling lost
- red and glazed patches
38
Q

Psoriasis balanitis - diagnosis?

A

Clinical if psoriasis elsewhere on body

BIopsy

39
Q

Psoriasis balanitis - biopsy?

A

Parakeratosis

acanthosis with elongation of rete ridges

40
Q

Psoriasis balanitis - treatment?

A

Emollient
MILD to MODERATE topical steroid
Topical CALCITRIOL

41
Q

Why should coal tar preparation be avoided for psoriasis balanitis?

A

Increases risk of genital cancers

42
Q

Circinate balanitis - aetiology?

A

Post infective syndrome (Reiter’s disease)
Triggered by urethritis or enteritis
Overlaps with psoriasis

43
Q

Circinate balanitis - signs?

A

Greyish white areas on glans
coalesce to form ‘geographical’ areas
white margin
Look for other features of Reiter’s

44
Q

Circinate balanitis - management?

A

screen for STIs including syphilis
Treat STI
Treat as for psoriasis but may require more potent steroid

45
Q

Irritant/allergic balanitis - aetiology?

A

Associated with IRRITANTS
- frequent washing with soaps
History of ATOPY
- immediate hypersensitivity eg latex condoms
- delayed hypersensitivity eg exposure to topical agents

46
Q

What may be useful in the investigation of allergic balanitis?

A

Patch testing

Intradermal skin tests

47
Q

Irritant/allergic balanitis - treatment?

A

Avoid precipitant - stop soaps
Emollient for moisturiser and soap substitute
Hydrocortisone 1% once to twice daily
+/- anti fungal or antibiotic

48
Q

Fixed drug eruption balanitis - aetiology?

A

Uncommon
Penis more commonly affected part of body
Rarely due to drug taken by sexual partner

49
Q

Fixed drug eruption balanitis - potential precipitants?

A

Tetracyclines
Salicylates
Paracetamol
Hypnotics

50
Q

Fixed drug eruption balanitis - appearance?

A

Well demarcated lesions
Erythematous
Bullous +/- ulceration sometimes
Brown pigmentation as inflammation settles

51
Q

Fixed drug eruption balanitis - treatment?

A

No treatment - usually resolve
mild to moderate topical steroids twice daily
Systemic steroids (rarely)

52
Q

Erythroplasia of Queyrat - what is it?

A

PRE-MALIGNANT condition of PENIS

Glans, meatus, prepuce

53
Q

What proportion of Erythroplasia of Queyrat progress to invasive cancer?

A

30%

54
Q

Erythroplasia of Queyrat - aetiology

A

triggered by co-infection with multiple types of PAPILLOMA VIRUS

55
Q

Erythroplasia of Queyrat - clinical appearance?

A 
Red
Velvety
well circumscribed
glans
raised white patches
56
Q

If induration is present on examination of Erythroplasia of Queyrat what does this suggest?

A

Squamous cell carcinoma

57
Q

Erythroplasia of Queyrat - diagnosis?

A

BIOPSY essential

58
Q

Erythroplasia of Queyrat - treatment?

A 
SURGICAL excision (local excision)
Topical is option
- fluorouracil cream 5%
- cryotherapy
- imiquimod 
- photodynamic therapy
59
Q

Erythroplasia of Queyrat - follow up?

A

Obligatory to assess for recurrence

minimum annually

60
Q

Bowen’s disease of penis - what is it?

A

cutaneous carcinoma in siu

61
Q

Bowen’s disease - clinical features?

A

Scaly, discrete, erythematous plaque

62
Q

What proportion of Bowen’s disease progress to squamous cell cancer?

A

20%

63
Q

Bowen’s disease - diagnosis?

A

BIOPSY essential

64
Q

Bowen’s disease - treatment?

A

Similar to Erythroplasia of Queyrat

  • local surgical excision
  • topical
65
Q

Bowenoid papulosis - clinical feature?

A

Discrete PAPULES to PLAQUES

often PIGMENTED

66
Q

Bowenoid papulosis - which HPV type is linked to it?

A

18

67
Q

Bowenoid papulosis - management?

A

BIOPSY essential - premalignant change
local excision
topical

68
Q

What are the premalignant conditions that may present as balanoposthitis?

A

Erythroplasia of Queyrat
Bowen’s disease
Bowenoid papulosis
these form a continuum with penile intraepithelial neoplasia (PeIN) but vary in clinical presentation and natural history

69
Q

What is the approach to management of premalignant conditions that may present as balanoposthitis?

A 
BIOPSY
local excision
or 
topical treatments
annual follow up minimum

DipGUM (39 decks)

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