Zoon's Balanitis - Update of Clinical Spectrum and Management

Abstract

Zoon's balanitis or balanitis plasmacellularis circumscripta is a chronic inflammatory disorder of the genital mucosa that can affect both males and females (Zoon's vulvitis). It is not a sexually transmitted disease but can still cause anxiety to the patients because of its chronic nature. Hence, proper diagnosis and early management are necessary. It is a clinical mimicker of other commoner genital dermatoses and is mostly a diagnosis of exclusion when other diseases have been ruled out. It is characterised by a well-demarcated shiny erythematous patch or plaque over the genital mucosa. Histopathological examination becomes necessary when we are unable to differentiate it from premalignant lesions. It reveals lozenge-shaped keratinocytes with siderophages, haemorrhages and variable plasma cell infiltrate in the dermis. Dermoscopy shows spermatozoa-like, convoluted vessels with structureless red orange areas. Response to topical therapy alone is not always satisfactory. However, lasers and surgical management can provide long-term remission.

Keywords: Diagnosis; recent updates; treatment; zoon’s balanitis.

Figure 1

Shiny erythematous plaque over the glans in a middle-aged male

Figure 2

Well-demarcated erythematous patch over glans in an elderly male

Figure 3

(a) Biopsy from the lesion showing superficial full thickness epithelial ulceration with few neutrophils and spongiosis. Dense diffuse sheet like inflammatory infiltrate predominantly composed of plasma cells admixed with lymphocytes present in most of the dermis. (b) Predominant plasma cell infiltrate in the dermis with few lymphocytes

Figure 4

Dermoscopy of Zoon’s balanitis showing structureless orange red areas with dotted, short linear and arborising vessels