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Zoon’s Balanitis (Balanitis Circumscripta Plasmacellularis) – a Case Report with a Review of Literature

Received: 13 July 2023    Accepted: 2 August 2023    Published: 22 August 2023
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Abstract

Zoon's balanitis or balanitis circumscripta plasmacellularis is a rare, idiopathic, chronic, benign, inflammatory disease of the genital mucosa of non-sexually transmitted nature. Etiopathogenesis is not fully understood, but the moist environment and chronic irritation are considered as important triggers. It occurs mainly in uncircumcised middle- and elderly men, but there are single cases in circumcised men. Affects the glans penis and foreskin. It is also rarely seen in women, such as Zoon's vulvitis, with predilectation involvement of labia minora. The article presented an overview of epidemiology, clinical performance, histopathological characteristics, diagnostic criteria and diagnostic methods of Zoon's balanitis. In addition, the differential diagnosis of the disease is discussed. Treatment methods are considered and circumcision is highlighted as the "gold standard" and first choice. We present a 53-year-old man with a well-circumscribed erythematous plaques on the glans penis and the inner surface of the foreskin from 10 years. Histologically plasmocyte infiltrate is established. Based on the correlation of history, dermatological status and histopathological result was diagnosed Zoon's balanitis. Conservative topical therapy was our preferred way of treatment. On an outpatient basis, we recommended personal genital hygiene, mometasone furoate cream 0.1% for 2 weeks and tacrolimus 0.1% ointment for 1 month. A control examination after 1 and a half months found a good clinical result with mild residual erythema. The patient was explained both the need for regular clinical and histological monitoring due to the carcinogenic potential of the lesions and the option of therapeutic circumcision.

Published in International Journal of Clinical Dermatology (Volume 6, Issue 2)
DOI 10.11648/j.ijcd.20230602.11
Page(s) 14-17
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Zoon Balanitis, Circumcision, Nonvenereal Disease, Topical Calcineurin Inhibitors, Lasers

References
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[3] Damiani L, Quadros M, Posser V, et al. Zoon vulvitis. An Bras Dermatol. 2017; 92 (5 Suppl 1): 166-168.
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[6] Lepe K, Salazar FJ. Balanitis Circumscripta Plasmacellularis (Plasma Cell Balanitis, Zoon Balanitis) [Updated 2019]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482129/
[7] Toker SC, Baskan EB, Tunali S, et al. Zoon's balanitis in a circumcised man. J Am Acad Dermatol. 2007; 57 (Suppl 2): 6-7.
[8] Adégbidi H, Atadokpèdé F, Dégboé B, et al. [Zoon's balanitis in circumcised and HIV infected man, at Cotonou (Benin)]. Bull Soc Pathol Exot. 2014; 107 (3): 139-141.
[9] Porter WM, Bunker CB. The dysfunctional foreskin. Int J STD AIDS. 2001; 12: 216-220.
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[19] Arzberger E, Komericki P, Ahlgrimm-Siess V, et al. Differentiation between balanitis and carcinoma in situ using reflectance confocal microscopy. JAMA Dermatol. 2013; 149: 440-445.
[20] Errichetti E, Lacarrubba F, Micali G, et al. Dermoscopy of Zoon's plasma cell balanitis. J Eur Acad Dermatol Venereol. 2015; 30: 2137-2139.
[21] Yoganathan S, Bohl TG, Mason G. Plasma cell balanitis and vulvitis (of Zoon). A study of 10 cases. J Reprod Med. 1994; 39: 939-944.
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[23] Santos-Juanes J, Sánchez del Río J, Galache C, et al. Topical tacrolimus: An effective therapy for Zoon balanitis. Arch Dermatol. 2004; 140: 1538-1539.
[24] Hernandez-Machin B, Hernando LB, Marrero OB, et al. Plasma cell balanitis of Zoon treated successfully with topical tacrolimus. Clin Exp Dermatol. 2005; 30: 588-589.
[25] Kyriakou A, Patsatsi A, Patsialas C, et al. Therapeutic efficacy of topical calcineurin inhibitors in plasma cell balanitis: Case series and review of the literature. Dermatology. 2014; 228: 18-23.
[26] Bardazzi F, Antonucci A, Savoia F, et al. Two cases of Zoon's balanitis treated with pimecrolimus 1% cream. Int J Dermatol. 2008; 47: 198-201.
[27] Stinco G, Piccirillo F, Patrone P. Discordant results with pimecrolimus 1% cream in the treatment of plasma cell balanitis. Dermatology. 2009; 218: 155-158.
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[31] Baldwin HE, Geronemus RG. The treatment of Zoon's balanitis with the carbon dioxide laser. J Dermatol Surg Oncol. 1989; 15: 491-494.
[32] Albertini JG, Holck DE, Farley MF. Zoon's balanitis treated with Erbium: YAG laser ablation. Lasers Surg Med. 2002; 30: 123-126.
[33] Wollina U. Erbium-YAG-laser treatment of balanoposthitis chronica circumscripta benigna plasmacellularis Zoon. Med Laser Appl. 2006; 21: 23-26.
[34] Pinto-Almeida T, Vilaça S, Amorim I, et al. Complete resolution of Zoon balanitis with photodynamic therapy – A new therapeutic option? Eur J Dermatol. 2012; 22: 540-541.
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[36] Bari O, Cohen PR. Successful Management of Zoon’s Balanitis with Topical Mupirocin Ointment: A Case Report and Literature Review of Mupirocin-Responsive Balanitis Circumscripta Plasmacelluaris. Dermatol Therapy. 2017; 7: 203–210.
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Cite This Article
  • APA Style

    Ivanka Temelkova, Valentina Broshtilova, Svetlana Bezhanova, Atanas Batashki, Yoanna Velevska, et al. (2023). Zoon’s Balanitis (Balanitis Circumscripta Plasmacellularis) – a Case Report with a Review of Literature. International Journal of Clinical Dermatology, 6(2), 14-17. https://doi.org/10.11648/j.ijcd.20230602.11

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    ACS Style

    Ivanka Temelkova; Valentina Broshtilova; Svetlana Bezhanova; Atanas Batashki; Yoanna Velevska, et al. Zoon’s Balanitis (Balanitis Circumscripta Plasmacellularis) – a Case Report with a Review of Literature. Int. J. Clin. Dermatol. 2023, 6(2), 14-17. doi: 10.11648/j.ijcd.20230602.11

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    AMA Style

    Ivanka Temelkova, Valentina Broshtilova, Svetlana Bezhanova, Atanas Batashki, Yoanna Velevska, et al. Zoon’s Balanitis (Balanitis Circumscripta Plasmacellularis) – a Case Report with a Review of Literature. Int J Clin Dermatol. 2023;6(2):14-17. doi: 10.11648/j.ijcd.20230602.11

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  • @article{10.11648/j.ijcd.20230602.11,
      author = {Ivanka Temelkova and Valentina Broshtilova and Svetlana Bezhanova and Atanas Batashki and Yoanna Velevska and Petar Vatov and Irina Iungareva and Sonya Marina},
      title = {Zoon’s Balanitis (Balanitis Circumscripta Plasmacellularis) – a Case Report with a Review of Literature},
      journal = {International Journal of Clinical Dermatology},
      volume = {6},
      number = {2},
      pages = {14-17},
      doi = {10.11648/j.ijcd.20230602.11},
      url = {https://doi.org/10.11648/j.ijcd.20230602.11},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcd.20230602.11},
      abstract = {Zoon's balanitis or balanitis circumscripta plasmacellularis is a rare, idiopathic, chronic, benign, inflammatory disease of the genital mucosa of non-sexually transmitted nature. Etiopathogenesis is not fully understood, but the moist environment and chronic irritation are considered as important triggers. It occurs mainly in uncircumcised middle- and elderly men, but there are single cases in circumcised men. Affects the glans penis and foreskin. It is also rarely seen in women, such as Zoon's vulvitis, with predilectation involvement of labia minora. The article presented an overview of epidemiology, clinical performance, histopathological characteristics, diagnostic criteria and diagnostic methods of Zoon's balanitis. In addition, the differential diagnosis of the disease is discussed. Treatment methods are considered and circumcision is highlighted as the "gold standard" and first choice. We present a 53-year-old man with a well-circumscribed erythematous plaques on the glans penis and the inner surface of the foreskin from 10 years. Histologically plasmocyte infiltrate is established. Based on the correlation of history, dermatological status and histopathological result was diagnosed Zoon's balanitis. Conservative topical therapy was our preferred way of treatment. On an outpatient basis, we recommended personal genital hygiene, mometasone furoate cream 0.1% for 2 weeks and tacrolimus 0.1% ointment for 1 month. A control examination after 1 and a half months found a good clinical result with mild residual erythema. The patient was explained both the need for regular clinical and histological monitoring due to the carcinogenic potential of the lesions and the option of therapeutic circumcision.},
     year = {2023}
    }
    

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  • TY  - JOUR
    T1  - Zoon’s Balanitis (Balanitis Circumscripta Plasmacellularis) – a Case Report with a Review of Literature
    AU  - Ivanka Temelkova
    AU  - Valentina Broshtilova
    AU  - Svetlana Bezhanova
    AU  - Atanas Batashki
    AU  - Yoanna Velevska
    AU  - Petar Vatov
    AU  - Irina Iungareva
    AU  - Sonya Marina
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    DO  - 10.11648/j.ijcd.20230602.11
    T2  - International Journal of Clinical Dermatology
    JF  - International Journal of Clinical Dermatology
    JO  - International Journal of Clinical Dermatology
    SP  - 14
    EP  - 17
    PB  - Science Publishing Group
    SN  - 2995-1305
    UR  - https://doi.org/10.11648/j.ijcd.20230602.11
    AB  - Zoon's balanitis or balanitis circumscripta plasmacellularis is a rare, idiopathic, chronic, benign, inflammatory disease of the genital mucosa of non-sexually transmitted nature. Etiopathogenesis is not fully understood, but the moist environment and chronic irritation are considered as important triggers. It occurs mainly in uncircumcised middle- and elderly men, but there are single cases in circumcised men. Affects the glans penis and foreskin. It is also rarely seen in women, such as Zoon's vulvitis, with predilectation involvement of labia minora. The article presented an overview of epidemiology, clinical performance, histopathological characteristics, diagnostic criteria and diagnostic methods of Zoon's balanitis. In addition, the differential diagnosis of the disease is discussed. Treatment methods are considered and circumcision is highlighted as the "gold standard" and first choice. We present a 53-year-old man with a well-circumscribed erythematous plaques on the glans penis and the inner surface of the foreskin from 10 years. Histologically plasmocyte infiltrate is established. Based on the correlation of history, dermatological status and histopathological result was diagnosed Zoon's balanitis. Conservative topical therapy was our preferred way of treatment. On an outpatient basis, we recommended personal genital hygiene, mometasone furoate cream 0.1% for 2 weeks and tacrolimus 0.1% ointment for 1 month. A control examination after 1 and a half months found a good clinical result with mild residual erythema. The patient was explained both the need for regular clinical and histological monitoring due to the carcinogenic potential of the lesions and the option of therapeutic circumcision.
    VL  - 6
    IS  - 2
    ER  - 

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Author Information
  • Department of Dermatology and Venereology, Medical Institute of the Ministry of Internal Affairs, Sofia, Bulgaria

  • Department of Dermatology and Venereology, Military Medical Academy, Sofia, Bulgaria

  • Department of Gastroenterology, Medical Institute of the Ministry of Internal Affairs, Sofia, Bulgaria

  • Department of Special Surgery, Medical University, Plovdiv, Bulgaria

  • Department of Infectious Diseases, Parasitology and Dermatovenereology, Medical University, Varna, Bulgaria

  • Department of Surgical Diseases, Medical University, Varna, Bulgaria

  • Department of Dermatology and Venereology, Medical Institute of the Ministry of Internal Affairs, Sofia, Bulgaria

  • Department of Dermatology and Venereology, Medical Institute of the Ministry of Internal Affairs, Sofia, Bulgaria

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