Indian Journal of Urology
CASE REPORT
Year
: 2002  |  Volume : 18  |  Issue : 2  |  Page : 173--175

Zoon's balanitis - diagnosis and follow-up


Datteswar Hota, Rajarshi Basu, Rabinarayan Senapati 
 Department of Urology, Sriram Chandra Bhanja Medical College & Hospital, Cuttack, India

Correspondence Address:
Datteswar Hota
D-3/2. Near I.M.A, House, Medical Road, Ranihat, Cuttack (Orissa) - 753 007
India

Abstract

Zoon«SQ»s balanitis, is a chronic erosive lesion on glans penis, which on biopsy shows a plasma cell infiltrate in dermal layers. It is typical in uncircumcised males. We are reporting a rare case of Zoon«SQ»s balanitis in our insti­tution. A 21-year-old unmarried male presented with pain and discharge from penis. A velvety patch was noted over glans. He underwent circumcision and the patch was ex­cised and sent for biopsy. Histopathological report was consistent with balanitis circumscripta plasmacellularis. We reviewed the literature about similar reports.



How to cite this article:
Hota D, Basu R, Senapati R. Zoon's balanitis - diagnosis and follow-up.Indian J Urol 2002;18:173-175


How to cite this URL:
Hota D, Basu R, Senapati R. Zoon's balanitis - diagnosis and follow-up. Indian J Urol [serial online] 2002 [cited 2020 Oct 22 ];18:173-175
Available from: https://www.indianjurol.com/text.asp?2002/18/2/173/37634


Full Text

 Introduction



Since the original description of a distinctive balanitis by Zoon [9] (1952) there have been only sporadic case re­ports of Zoon's balanitis, a chronic erosive lession on glans penis which on biopsy shows a plasma cell infiltrate. This has given its typical name balanitis circumscripta plasma cellularis and is unique in that it occurs only in glans or prepuce of uncircumcised males. [2] Though there are a few regimens for its treatment, circumcision is the age-old pro­cedure. We are reporting this rare case we have encoun­tered in the outpatient department of our hospital and followed up for 6 months.

 Case Report



A 21-year-old unmarried male presented with pain in the penis and staining of the undergarments for 4 months. He was nondiabetic, not hypertensive. On general exami­nation of the patient no abnormality was detected. Genital examination revealed phimosis, difficulty in retraction of prepuce and discomfort during the procedure. A velvety patch on the dorsal aspect of glans and inner preputial layer at the corona glandis was noted of size 1.8 x 1.2 cm. Other parts of glans, prepuce and penis were unremark­able [Figure 1]. The patient was subjected to investigation and subsequently circumcision & excision of the velvety lesion. Sparfloxacin was given in dose of 200 mg for 10 days. Histopathological report showed epidermal atrophy and dense plasma cells infiltration of dermis [Figure 2]. Re­covery was uneventful. The lesion did not recur at 6 months follow-up.

 Comments



Zoon (1952) reported 8 cases of a benign inflammatory balanitis which he differentiated from Erythroplasia of Queyrat. In male patients, the typical appearances were solitary asymptomatic circumscribed macules with a maxi­mum diameter of 3 cm. Characteristically glazed orange­coloured macular erythema with multiple pin point bright red spots (Cayennepepper spots) [7] was present. Duration of history can range from 4 months to 1 year. Symptoms of pain, irritation and discharge occur.[6] At times the le­sion may be erosive and is usually asymptomatic but chronic.[2] All the male patients reported were uncircum­cised. The histological features of Zoon's balanitis are distinctive. The characteristic epidermal changes of atrophy, loss of reteridges, `Lozenge Keratinocyte' and `watery spongiosis' are perhaps unique to this condition. In the dermis, a dense bandlike or lichenoid infiltrate is present, frequently extending to mid reticular dermis. Plasma cells were predominant in the infiltrate and usually exceeded 50% of the cells present. [7] Changes in dermal vasculature were prominent and characteristic. The etiology is poorly understood. Chronic infection by Mycobacterium smegmatis has been postulated. [5] The course is chronic and poorly responsive to topical treatment but it can resolve on circumcision. [3],[4] Reports exist about successful treat­ment of individual lesions with carbondioxide laser. [1]

References

1Baldwin HE, Geronemus RG. The treatment of Zoon's balanitis with CO, laser. J Dermatol Surg Oncol 1989: 15: 491-499.
2Marjolis DJ. Cutaneous disease of the male external genitalia. In Walsh PC. Retik AB. Vaughan ED, Wein AJ (eds.). Campbell's Urol­ogy. Saunders. Philadelphia 1998; 1: 729.
3Gamier G. Benign plasma cell erythroplasia. Br J Dermatol 1957: 69: 77.
4Kmnar B. Sharma R. Rajgopalan M. Radothra BD. Plasma cell balanitis : clinical and histopathological features - response to circumcision. Genitourin Med 1995; 71: 32-34.
5Montgomery D (ed.). Dermatopathology. London, Harper and Row.1967:2:988.
6Murray JG. Fletcher MS. Yates-Bell AJ et al. Plasma cell balanitis of Zoon. Br J Urol 1986; 58: 689-691.
7Souteyrand P. Wong E, MacDonald DM. Zoon's balanitis (balanitis circumscripta plasmacellularis). Br J Dermatol 1981; 105: 195­-199.
8Sonnex TS. Dawber RPR, Ryan TJ. Ralfs IG. Zoon's (plasma cell) balanitis : treatment by circumcision. Br J Dermatol 1982: 106: 585-588.
9Zoon JJ. Balanoposthite chronique circonscrite benign a plasmocytes. Dermatologica 1952: 105:1.