Circinate Balanitis & Balanitis Tratamiento

Highly Specialists lecture on Balanitis talks about one of the issue of diabetic patients Circinate Balanatis (balanitis glande) meaning inflammation of the glans penis, the sintomas de balanitis, balanitis causas and ultimate way to balanitis tratamiento.

To what I have researched, in most cases Balanitis circinate can be tratamiento with antibiotic creams (like terrasil balanitis cream) & pills and usually is not a serious condition. In about 3 to 5 days of starting the treatment, you will start to see Balanitis sintomas coming down. However, it can turn painful giving rise to other health problems as well if left untreated.

Enough of my ranting. Now I bring you a well researched information from Specialists giving review on Balanitis. Read on as he talks on the youtube video on his channel Medgeeks.https://www.youtube.com/watch?v=J11MwDik4DE

Article: “Balanitis – A Clinical Review”

Today’s topic is going to be on balanitís. Now balanitis means we have inflammation of the glans penis (Circinate balanitis or balanitis glande). A couple of other quick definitions before we jump into this topic posthitis means we have inflammation of the prepuce and balanoposthitis means we have inflammation of the glans and of the prepuce. Now posthitis and balanoposthitis is only going to be seen in uncircumcised males. Balanitis can be seen in both uncircumcised and in circumcised males.

For the most part in clinical practice everything is kind of clumped together into the term balanitis which means we have inflammation of the glans and of the foreskin. Now we have to keep in mind and we have to remember the normal physiology of the child. If the child is uncircumcised it’s very normal to have a physiological phimosis. Phimosis means that we can’t retract the foreskin back over the glans. This is normal we have adhesions that attach these foreskin to the glans early in life.

For the most part this is going to separate naturally by 11 years of age, however it’s still considered normal to have this attachment by 17 years of age and so long as the patient can urinate properly we don’t need to do anything about this whatsoever. Now moving on to the

Etiology of Balanitis (Balanitis causas) :-

Now the inflammation connected could be due to infectious causes or non-infectious causes.

The infectious causes are really going to include
 – anaerobic infection
 – Candida
 – gonorrhea
 – HSV (herpes simplex virus) which is considered rare.
 – HPV again is considered rare and finally
 – strep infection

The strep infection can be group A and it can be group B.

The non-infectious causes here going to include
 – allergy
 – contact dermatitis
 – atopic dermatitis
 – psoriasis
 – drug eruptions and
 – poor hygiene

Alright moving on to the

Specific Etiologies (balanitis causas) one by one now…:-

Candida infection :- 

This is going to be most common in males who have a female partner with recurrent infection (balanitis candidiásica) . It can also be seen in children especially if there’s recent antibiotic use or if we have contact dermatitis. Now in children really the most common cause here is going to be poor hygiene.

Now when talking about bacteria most common etiologies here going to be e-coli and enterococci strep infection (group A & B) and staphylococcus aureus (la balanitis es contagiosa).

Like we said the strep infection can either be Group A or it can be Group B.

Now contact dermatitis and allergy:-
Now only can balanitis be due to poor hygiene which means we don’t have the proper cleaning technique but it can also be due to excessive cleaning. so the success of cleaning with water and soap is going to irritate and it’s going to over dry the glands which can ultimately lead to balanitis.

Drug eruptions can also occur now. Drug eruptions for the most part are going to occur in few hours or 30 minutes. I should say to a few hours after ingesting the medication. common medications here that are implicated are going to be tetracyclines salicylates and sedative hypnotics. And really balanitis can be the sole manifestation of a drug eruption.

Now one last thing regarding Candida infection.

Cadida infection that results in balanitis can really be the initial presentation of diabetes especially in an otherwise healthy male. So if we have balanitis and this has never occurred before or if we have recurrent balanitis it’s probably a good idea do a quick glucose check to rule out diabetes. So that’s those are the etiologies here.

Let’s get into the Signs and Symptoms of Balanitis (sintomas de balanitis or
balanitis sintomas)
:-

All right moving on to these symptoms of balanitis (balanitis sintomas), now for the most part, patients are going to present with a rash which are going to be present as erythematous papules which can either ulcerate or scale. Patients are going to have Pruritis, pain and tenderness as well.

Now really if this is left untreated then this can eventually lead to adhesions, edema, exudates which can ultimately lead to phimosis and or para phimosis. And paraphimosis is really going to be a urologic emergency.

Paraphimosis means we have the foreskin that’s retracted behind the glans causing a tourniquet effect. Now regarding the paraphimosis, there are times where paraphimosis can actually be mistaken for balanitis. Like we said balanitis presents with erythematous, rash paraphimosis can also present with a red glans (balanitis glande).

And this is because of the constricting effect that occurs with the foreskin constricting behind the glans. What happens is this tourniquet effect is going to reduce venous outflow but it’s still going to allow for arterial inflow which creates this erythematous glands. So don’t mistake paraphimosis with balanitis.

All right so now there are going to be some possible indicators towards the etiology of balanitis (causas) if we have strep infection. Anywhere else on the body skin or throat then this is a possible clue to having strep as an etiology for balanitis.

Foul-smelling discharge might clue you into having anaerobic infection, satelite lesions are going to be present with Candida infection (balanitis candidiásica). And if we have discharge oral ulcerations of any kind we have to do an STD work up especially for chlamydia and gonorrhea.

Finally when doing the physical exam if we palpate the suprapubic area and we have tenderness to palpation there, this is where the bladder resides and this might be an indication of a complicated balanitis which means we have urinary retention and these patients ultimately need to be catheterized immediately.

Moving on to the

Diagnosis of Balanitis (como curar la balanitis):-

Now the very first thing that we have to do is exclude the possibility of paraphimosis. Like we said, this is a urological emergency and we really don’t want to miss this diagnosis. Now once we’ve excluded that possibility, the next step is to really do a history in a physical.

And we can really diagnose contact dermatitis, poor hygiene and Candida infection (balanitis candidiásica) on clinical grounds. These are fairly easy to diagnose and go ahead and start the patient on treatment as appropriate (tratamiento para la balanitis).

For those cases that are not quite so clear then we probably want to do some type of laboratory testing. Things are going to include

 – glucose screening to make sure we don’t have diabetes, 

– microscopy and we’re going to want to do a

 – chlamydia and

 – gonorrhea screening on certain patients as well.

Bacterial cultures really add little to the diagnosis but like we said if you’re uncertain of the etiology (balanitis causas) go ahead and get a bacterial culture also consider getting a group a strep culture like we said strep is a possible etiology strep can be transmitted orally, through oral sex so we have to make sure that that’s not the reason the patient is presenting with balanitis, also be on the lookout for inverse psoriasis.

Inverse psoriasis presents a little bit differently than the classic presentation of psoriasis this is going to be noted in the intertriginous areas and it’s not going to have the scaling or the silver plaques that are going to be normally associated with classic psoriasis, so inverse psoriasis also scabies HPV (hpv balanitis).

These types of infections are also going to present with papules and it’s also going to present with balanitis like symptoms (balanitis sintomas). Lastly we want to look for lichen planus. now lichen planus can present on the genital area and it’s going to present with vaiolaceous papules that are present over the glans.

So these are different possible etiologies that might resemble balanitis. these last few things here, we want to exclude these as the possible differential diagnosis. Moving on to the

Treatment of Balanitis (balanitis tratamiento or tratamiento para la balanitis):-

Now to really reduce these symptoms (sintomas de balanitis) that are associated with this, we’re going to want to have the patient do sitz bath and we’re going to want to have them perform proper hygiene. They should really get a q-tip pull the foreskin back and make sure that they’re cleaning properly, water irrigation especially at the beginning is also going to be very important here.

Now if we have improper hygiene, as a diagnosis then we continue doing these things. We also have to educate the patient on how to prevent this in the future. If they’re not properly cleaning then we have sweat, we have exfoliated skin, debris, bacterial organisms that are naturally produced on the floor, there are going to over produce and it’s going to lead to a recurrence.

So proper hygiene is very important. We will also want to educate the patient not to over clean with water and over clean with soap. Like we said this can lead to atopic dermatitis. This can cause irritation and over drying of the skin which ultimately leads to balanitis.

If we have candida infection, we’re going to treat with topical SOS clotrimazole or micanozole. We’re going to do this for one to three weeks and we can also use fluconazole 150 milligrams as a single dose or a Nystatin as alternative therapy.

But really first line here is going to be clotrimazole or micanozole for one to three weeks. Now if we have dermatitis or allergy as the possible etiology (balanitis causas), then we’re obviously going to want to remove the offending agent and then, you can also treat with hydrocortisone 1% cream.

Now I know a lot of people are scared of treating with the steroid especially in this area because it’s supposed to be contra-indicative, but it’s fine. Cream is going to be less potent than augments and 1% is going to be a very low dose.

Hydrocortisone is a very weak topical steroid, so you can really treat with hydrocortisone 1% cream twice daily but no more than one week. this is considered safe and this is going to help resolution of symptoms.

If we have a drug eruption then again this is going to be self-limiting. This is going to resolve on its own as soon as you stop the medication but if the patient have severe symptoms, again hydrocortisone 1% cream twice a day for no more than one week can be given.

If you’re considering anaerobic infection there to treat with the appropriate antibiotics options you’re going to accrued metronidazole 500 milligrams twice a day for one week. We can do augmentin which is going to be 875 over 125 twice a day for about seven to ten days as well. We can also use clindamycin cream applied twice daily again. this is going to be for one week duration.

If we’re thinking group A strep and this is going to be treated exactly the way we treat any other type of group strep infection. We’re going to choose penicillin. We’re going to do this for ten days. If we have a penicillin allergy then we can substitute with cephalosporin macrolide or clindamyosin. Again this is going to be treated no differently than any other type of group A strep infection.

Now if there’s no improvement after four to six weeks of treatment this is indication to refer to urologist for the appropriate check up and the appropriate treatment. Now one word of caution circling back to the issue of phimosis. If you try and resolve the phimosis by simply pulling the foreskin back over the glans you can precipitate paraphimosis, this is a urological emergency.

If this happens in the office, you have to refer to the ER immediately. So if you don’t have the appropriate knowledge or tools to treat the phimosis, I would suggest not pulling the foreskin back over the glans like we said this can precipitate para phimosis. All right so that concludes today’s lecture on Balanitis, take care and I’ll see you on the next lecture.

This lecture article “Balanitis – A Clinical Review” is courtesy from  YT channel Medgeeks https://www.youtube.com/watch?v=J11MwDik4DE

Conclusion – Circinate Balanitis & Balanitis Tratamiento:-

Here though you got tremendous wealth of information circinate balanitis & balanitis tratamiento, our discussion was limited Balanitis due to type 2 diabetes mellitus.  I believe, you need to address this situation in 2 ways. Short term and long term.  Short term could be some sort of injections or medications or cream to alleviate the immediate discomfort due to circinate balanitis / balanitis glande. But for a long term treatment, diabetes has to be reversed. Instead of going through the embarrassing situation of stripping your pants in front of doctor, why not reverse the root cause -> type 2 diabetes.

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