Clinical Challenge: Asymptomatic Genital Rash - MPR

Clinical Challenge: Asymptomatic Genital Rash

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A 65-year-old man presents with an asymptomatic rash on his penis that has persisted for 2 weeks. He denies prior episodes of a similar rash, any recent sexual contact, commencement of any new medications, or history of skin disease. Examination revealed shiny, well-demarcated erythematous patches of the corona and prepuce. No exudates or vesicles were apparent and inguinal nodes were nonpalpable. The patient was treated with tacrolimus ointment 0.1% and econazole cream, which resulted in resolution of the dermatitis at follow-up.

The patient was diagnosed with balanoposthitis, an inflammatory disorder involving the glans and prepuce. Predisposing factors include poor hygiene, noncircumcision, and irritation by smegma. It occurs more frequently in patients with underlying medical conditions such as diabetes mellitus and immunosuppression.1 Patients...

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The patient was diagnosed with balanoposthitis, an inflammatory disorder involving the glans and prepuce. Predisposing factors include poor hygiene, noncircumcision, and irritation by smegma. It occurs more frequently in patients with underlying medical conditions such as diabetes mellitus and immunosuppression.1 Patients with this disorder may complain of nonspecific symptoms such as burning and pruritus. Presentation typically includes erythema and papules with or without eroded satellite pustules.2

Balanoposthitis may be caused by infection, with the most common agent being Candida albicans.2 Other infectious agents include Streptococcus spp. and human papillomavirus.2,3 Antifungals are recommended for treatment of Candida balanoposthitis; treatment of bacterial infection is based on the organism detected by culture.

Other conditions that can affect the glans and prepuce include primary syphilis, contact dermatitis, fixed drug eruption, lichen planus, psoriasis, Bowen disease, and bowenoid papulosis.4

Stephen Schleicher, MD, is director of the DermDox Center for Dermatology, as well as an associate professor of medicine at Commonwealth Medical College and a clinical instructor of dermatology at Arcadia University and Kings College.

References

  1. 1. Edwards SK. Balanitis and balanoprosthitis: a reviewGenitourin Med. 1996;72(3):155-159.
  2. 2. Lisboa C, Ferreira A, Resende C, Rodrigues AG. Infectious balanoposthitis: management, clinical and laboratory features [published online January 19, 2009]. Int J Dermatol. doi: 10.1111/j.1365-4632.2009.03966.x
  3. 3. Edwards SK. European guideline for the management of balanoposthitisInt J STD AIDS. 2001;12(Suppl 3):68-72.
  4. 4. Edwards SK, Bunker CB, Ziller F, van der Meijden WI. 2013 European guideline for the management of balanoposthitisInt J STD AIDS. 2014;25(9):615-626.