Zoon's Balanitis Research Articles

Zoon balanitis: not a distinct clinicopathological entity?

Zoon balanitis (ZB) was originally described in the 1950s in patients with clinical features resembling erythroplasia of Queyrat, but with histology that demonstrated a plasma cell infiltrate without evidence of dysplasia. Subsequently, ZB has been extensively reported in the literature, reflecting widespread acknowledgement as an established distinct clinicopathological entity. However, its existence as such has been questioned and there have been suggestions in the literature that ZB represents either a non-specific irritant reaction pattern, or a part of the heterogenous clinicopathological complex of male genital lichen sclerosus (MGLSc). In this study, the entire historical literature of published cases of ZB was subject to review, to determine respectively whether clinical or histological features of MGLSc had been present and been overlooked. One hundred and one papers were reviewed. Seventy-five contained images purporting to be of ZB. Images that were deemed to be of inadequate quality or to present uninformative anatomical views were excluded. The images in 66 manuscripts were amenable to scrutiny; 98.5% of these images demonstrated clinical signs of MGLSc, such as adhesions, effacement of the coronal sulcus and the frenulum, tightening of the prepuce, constrictive posthitis, etiolation of the glans, lichenoid inflammation and sclerosis. These findings strongly suggest that ZB occurs in the vast majority of cases as a manifestation of MGLSc and that its recognition as a distinct clinicopathological entity should be questioned, if not discontinued.

Balanitis of Zoon treated with 30% salicylic acid lotion – A case series

Balanitis of Zoon or balanitis circumscripta plasmacellularis is a non-venereal balanitis affecting middle-aged uncircumcised men. It follows a benign protracted course with a minimal tendency for spontaneous resolution. Chronicity of disease and genital distribution is sufficient to evoke anxiety among subjects and is the primary reason for dermatological consultation. Many topical modalities (antibiotics, antifungals, and immunomodulators) have been resorted to as therapeutic measures with variable and unsatisfactory results and recurrences. Circumcision is a definitive and curative treatment. However, 30% salicylic acid (SA) lotion can prove to be a promising therapeutic alternative, especially for subjects reluctant for circumcision. We are presenting a case series of 10 patients with balanitis of the Zoon treated with 30% SA lotion.

Zoon's plasma cell balanitis associated with genital lichen planus.

Zoon's plasma cell balanitis associated with genital lichen planus.

Long-term follow-up of Zoon balanitis: a retrospective cohort study.

Long-term follow-up of Zoon balanitis: a retrospective cohort study.

Ulcerative Zoon balanitis in an HIV-infected male

Ulcerative Zoon balanitis in an HIV-infected male

Altered mRNA Expression of NFKB1 and NFKB2 Genes in Penile Lichen Sclerosus, Penile Cancer and Zoon Balanitis.

The nuclear factor-κB transcription factors 1 and 2 (NFKB1 and NFKB2) are key components of the NF-κB pathway, which responds to inflammatory signals. Since the NFKB1/2 factors are activated via different inflammatory molecules, we aimed to check their expression levels in penile cancer (PC), penile dermatoses: lichen sclerosus (PLS) and zoon balanitis (ZB). Skin biopsies from altered and healthy looking foreskin were obtained from 59 (49 LS; early PLS: 13, moderate PLS: 32, severe PLS: 4; 6 PC; 4 ZB) and unchanged foreskin from 13 healthy control adult males undergoing circumcision. NFKB1/2 mRNA levels were quantified by qPCR. The highest levels of NFKB1 and NFKB2 were observed in PC, ca. 22 and 3.5 times higher than in control, respectively. NFKB1 expression was correlated with PLS progression (rs = 0.667) and was ca. 20 times higher in advanced PLS than in controls and early PLS. Occurrence of micro-incontinence was associated with elevated NFKB1 levels in PLS. This is the first study regarding gene profiles of NFKB1/2 in PC and penile dermatoses. New drugs targeting modulation of canonical-activated NF-κB pathway should be studied and introduced to the treatment of PLS and PC apart from other treatments.

Dermoscopy of Lymphoplasmacellular Erosive Dermatitis of the Scalp Reveals Striking Similarities to Lymphoplasmacellular Balanitis of Zoon.

Not applicable

Cutaneous reactive B-cell lymphoid proliferations.

Cutaneous lymphoid hyperplasia (CLH), also known as cutaneous pseudolymphoma, is a spectrum of benign conditions characterized by reactive B- and T-cell cutaneous lymphocytic infiltrates. B-cell lymphoid proliferations are a heterogenous group of non-neoplastic cutaneous diseases that must be histopathologically distinguished from cutaneous B-cell lymphomas. These proliferations can be observed as reactive phenomena to infections, medications, allergens, neoplasms, and more. Furthermore, there are many inflammatory conditions that present with reactive B-cell infiltrates, including actinic prurigo, Zoon balanitis, Rosai-Dorfman disease, and cutaneous plasmacytosis. This review summarizes multiple cutaneous B-cell lymphoid proliferations within the major categories of reactive and disease-associated CLH. Further we discuss major discriminating features of atypical CLH and malignancy. Understanding the specific patterns of B-cell CLH is essential for the proper diagnosis and treatment of patients presenting with such lesions.

A systematic review of the efficacy and safety of topical cyclosporine in dermatology.

Cyclosporine-A (Cyc-A) was initially prescribed as systemic therapy for patients receiving solid organ transplants or in patients with graft versus host disease (GVHD). Topical Cyc-A is an ideal form of cyclosporine in the treatment of mucocutaneous disorders as it causes fewer systemic side effects and has more stable results than steroids; however, poor absorption through the skin makes the development of new formulations necessary to improve skin permeability. The aim of this study was to evaluate the efficacy and safety of topical Cyc-A in different dermatological conditions. A thorough systematic review was performed on PubMed/Medline, Embase, Scopus, and Web of Science databases as well as Google Scholar, and relevant studies from 2000 until January 3, 2022, were selected. The study was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA). Topical Cyc-A was observed to be an effective medication in the treatment of oral lichen planus, psoriasis, burning mouth syndrome, Pyoderma Gangrenosum, and Zoon's balanitis. Adverse side effects such as dysphagia, burning sensation, lips swelling, and gastrointestinal upset were reported following Cyc-A mouthwash use, whereas mild erythema, dryness, and fissuring of the skin were observed following the Cyc-A lipogel application. Topical Cyc-A was found to be a good alternative to traditional treatment regimens for immune-mediated mucocutaneous conditions. Cyc-A can be considered as a safe and efficient option in cases of long-term treatment as it does not have the same adverse effects of long-term steroids.

The Role of Erbium: Yag Laser in the Management of Zoon's Balanitis - A Case Report with Mini Review.

The Role of Erbium: Yag Laser in the Management of Zoon's Balanitis - A Case Report with Mini Review.

Dermoscopic Characterization of Zoon Balanitis: First Case Series from Asia.

Zoon balanitis is a rare chronic inflammatory dermatosis involving genitalia. It is often misdiagnosed or diagnosed late leading to significant patient distress. Dermoscopy can act as a useful modality in prompt diagnosis of zoon balanitis. Herein, we report dermoscopic findings in twelve lesions of zoon balanitis in seven patients.

Zoon Balanitis and Lichen Sclerosus: An Uncommon Association


 
 
 Zoon balanitis and lichen sclerosus are both chronic inflammatory disorders of the genital mucosa that usually affect middle-aged or elderly uncircumcised men.Although the precise etiology of Zoon balanitis is still unclear, a pathogenic role of irritant and mechanical factors has been suggested. Therefore, foreskin sclerosis and phimosis caused by male genital lichen sclerosus may trigger the development of Zoon balanitis. However, until the present, only three cases with clinical and histopathologic features consistent with synchronous presentation of both disorders have been described.
 We report the case of a 70-year-old male who developed Zoon balanitis in association with lichen sclerosus, that cleared only after circumcision.
 
 

Lichen Sclerosus and Phimosis – Discrepancies Between Clinical and Pathological Diagnosis and Its Consequences

To assess the accuracy of clinical diagnoses and the true incidence of lichen sclerosus (LS) in patients with phimosis. The 92 adult male patients who were qualified for circumcision due to phimosis, were included in the study. The patients were diagnosed clinically by a urologist and dermatologist before the surgical procedure. After the circumcision, the resected foreskins were examined by 2 independent uropathologists. Preoperative clinical diagnosis of LS was established in 54 patients (58.7%); healthy-looking skin in 26 (28.3%) and other penile diseases in 12 (13.1%) patients. After histopathological examination, the diagnosis of LS was established in 62 patients (67.4%), but only in 44 patients with previous LS clinical diagnosis. LS was histopathologically confirmed in 18 other patients with clinically diagnosed healthy skin (n=17) or lichen planus (n=1). Healthy skin was histopathologically confirmed in 10 cases in patients diagnosed clinically before as LS. Other 15 histopathological diagnoses were Zoon balanitis (n=3), nonspecific balanitis (n=5), lichen planus (n=1), psoriasis (n=1), invasive penile cancer (n=3), Bowen's disease (n=1), penile intraepithelial neoplasia 2 usual type (n=1). LS has been revealed as the most common histopathological diagnosis in patients undergoing circumcision in our study. Histopathological examination seems to be necessary to exclude this disease.

Dermoscopy in Monitoring and Predicting Therapeutic Response in General Dermatology (Non-Tumoral Dermatoses): An Up-To-Date Overview.

Besides the well-known use in supporting the non-invasive diagnosis of non-tumoral dermatoses (general dermatology), dermoscopy has been shown to be a promising tool also in predicting and monitoring therapeutic outcomes of such conditions, with the consequent improvement/optimization of their treatment. In the present paper, we sought to provide an up-to-date overview on the use of dermoscopy in highlighting response predictor factors and evaluating therapeutic results in the field of general dermatology according to the current literature data. Several dermatoses may somehow benefit from such applications, including inflammatory conditions (psoriasis, lichen planus, dermatitis, granulomatous conditions, erythro-telangiectatic rosacea, Zoon balanitis and vulvitis, cutaneous mastocytosis, morphea and extra-genital lichen sclerosus), pigmentary disorders (vitiligo and melasma) and infectious dermatoses (scabies, pediculosis, demodicosis and viral warts).

Kappa and lambda immunohistochemistry and in situ hybridization in the evaluation of atypical cutaneous lymphoid infiltrates.

Atypical cutaneous lymphoid infiltrates are challenging lesions in dermatopathology. We present a summary of the literature regarding kappa and lambda immunohistochemistry (IHC) and in situ hybridization (ISH) in the evaluation of atypical cutaneous or mucosal lymphoid infiltrates. Relevant articles from 1967 to 2018 in the English language were identified and summarized. In the absence of larger studies, case series of n ≥ 3 were included. Sixty-three articles assessing kappa and lambda IHC and/or ISH were identified. Most focused on marginal zone lymphomas. Other lymphomas included follicle center lymphoma, diffuse large B-cell lymphoma, chronic lymphocytic leukemia/small lymphocytic lymphoma, mantle cell lymphoma, lymphoplasmacytic lymphoma, plasmablastic lymphoma, multiple myeloma, monoclonal gammopathy of undetermined significance, and polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, skin changes (POEMS). Non-neoplastic lesions included reactive lymphoid hyperplasia, cutaneous plasmacytosis, connective tissue disease, IgG4-related disease, acrodermatitis chronic atrophicans, Zoon balanitis, dermatitides, and infiltrates around epithelial dysplasias/neoplasias. Kappa and lambda IHC and ISH are useful tools in the evaluation of cutaneous B-cell lymphomas and plasma cell neoplasms. The literature supports that the detection of light-chain restriction by IHC and ISH is one of the most useful findings in the differential diagnosis of reactive lymphoid hyperplasia vs B-cell lymphoma with plasmacytic differentiation.

A case-control study of risk factors associated with Zoon balanitis in men.

Zoon balanitis (ZB) is a chronic inflammatory benign mucositis. Its etiopathogenesis still remains hypothetical and speculative. To determine risk factors associated with genital ZB in men. This is a case-control study including 30 patients diagnosed with ZB and 54 patients with dermatological diseases other than ZB enrolled in the Dermatological Clinic of the University of Padova, Italy, from September 2015 to June 2018. Univariate and multivariate logistic regression analyses were used for analysis of data collected. According to multivariate logistic regression analysis, risk factors for ZB were as follows: the mean daily cigarettes consumption (OR 1.065; 95% CI 1.8-11.4; P = 0.006) and the number of weekly foreskin retractions (OR 0.847; 95% CI 5.5-24.1; P = 0.003). There were no statistically significant differences between cases and controls according to age, presence of circumcision as well in number of sexual partners. To our knowledge, this is the first case-control study showing that smoking and poor genital hygiene are associated with being affected by ZB.

Handheld reflectance confocal microscopy, dermatoscopy and histopathological correlation of common inflammatory balanitis.

The term balanitis includes a variety of inflammatory skin diseases involving the glans penis whose clinical diagnosis may be challenging. A biopsy is often required to obtain a definitive diagnosis, although it is barely accepted by patients. Reflectance confocal microscopy (RCM), that provides a real-time, en face imaging of the epidermis and upper dermis, is currently utilized for the diagnosis of some neoplastic and inflammatory skin diseases. The aim of this study was to analyze the RCM handheld findings of some common balanitis and to correlate them with dermatoscopy and histopathological features. Thirty-two patients with biopsy-proven diagnosis of psoriatic balanitis (10 patients), Zoon's balanitis (11 patients) and lichen sclerosus et atrophicus (11 patients) were evaluated using a handheld RCM device and ×10 dermatoscopy. At the end of the study, each disorder presented specific RCM patterns that correlated with dermatoscopy and histopathological findings. The use of handheld RCM as complementary tool in everyday clinical practice for the evaluation of inflammatory diseases involving sensitive areas such as male genitalia, may contribute to reduce the need of invasive procedures.

Nonvenereal Penile Dermatoses: A Retrospective Study.

Context:A variety of nonvenereal diseases can affect the penis and diminish quality of life. Many present similar clinical features and a cutaneous biopsy may be necessary to clarify the diagnosis.Aims:To characterize nonvenereal penile dermatoses with histological confirmation in a southwestern Europe hospital during a 9-year period.Materials and Methods:A retrospective study was conducted. We reviewed all penile biopsies performed between January 1, 2007 and December 31, 2015 and studied the causes of the nonvenereal penile dermatoses.Results:The sample included a total of 108 patients, aged 62.9 (±17.8) years, between 16 years and 96 years of age. Eighteen dermatoses were identified. Inflammatory diseases were present in 65. 7% of patients (71/108) and neoplastic dermatoses in 34. 3% (37/108). Concerning inflammatory dermatoses, the most frequent were Zoon balanitis (27.8%, 30/108), followed by lichen sclerosus (15.7%, 17/108), psoriasis (11.1%, 12/108), and lichen planus (4.6%, 5/108). In patients with psoriasis, 10 had lesions only in the penis, similarly to all patients with lichen planus. The most frequent malignant tumor was squamous cell carcinoma (SCC) (15.7%, 17/108). The most common in-situ tumor was erythroplasia of Queyrat (8.3%, 9/108). A case of basal cell carcinoma (BCC) was found. Kaposi sarcoma and mycosis fungoides on penis were also diagnosed, as an additional form of presentation to their generalized disease.Conclusions:In this study, inflammatory diseases were the most frequently diagnosed dermatoses, while SCC was the most common malignant tumor found. In the majority of psoriasis and lichen planus cases, clinical lesions were only present in the genital area.

A study of pattern of nonvenereal genital dermatoses of male attending skin OPD of tertiary centre in Kalaburagi

<p class="abstract"><strong>Background:</strong> Dermatoses involving genital areas are not always sexually transmitted. The diseases, which are not sexually transmitted, are referred as nonvenereal dermatoses. These disorders are the cause of considerable concern to patients causing mental distress and guilt feeling in them. Nonvenereal dermatoses are quiet often a diagnostic dilemma to the treating physician also. The aim was to determine clinical and epidemiological pattern of nonvenereal dermatoses of male external genitalia.</p><p class="abstract"><strong>Methods:</strong> This was a descriptive study of 50 consecutive male patients over age of 18 years, with genital lesions of nonvenereal origin, attending the skin outpatient department of BTGH, Kalaburagi. Study was done for a period of 6 months.<strong></strong></p><p class="abstract"><strong>Results:</strong> The study included 50 male patients with nonvenereal genital lesions. A total of 14 nonvenereal genital dermatoses were noted. The most common nonvenereal genital dermatoses were vitiligo (20%), fixed drug eruptions (16%), scabies (14%), pearly penile papule (10%), and dermatophytoses (10%). Other dermatoses included psoriasis, plasma cell balanitis or Zoon's balanitis, lichen simplex chronicus, lymphangioma circumscriptum, squamous cell carcinoma, scrotal dermatitis, lichen planus, steatocystoma multiplex and candidiasis.</p><strong>Conclusions:</strong>This study helps in understanding the etiological causes of nonvenereal genital dermatoses and their pattern in this region.<p> </p>

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

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.