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CASE REPORT |
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| Year : 2002 | Volume
: 18
| Issue : 2 | Page : 173-175 |
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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
 Source of Support: None, Conflict of Interest: None  | Check |
 Abstract | | |
Zoon'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'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.
Keywords: Zoon′s Balanitis; Uncircumcised
How to cite this article:
Hota D, Basu R, Senapati R. Zoon's balanitis - diagnosis and follow-up. Indian J Urol 2002;18:173-5 |
| 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  een 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 | | |
| 1. | Baldwin HE, Geronemus RG. The treatment of Zoon's balanitis with CO, laser. J Dermatol Surg Oncol 1989: 15: 491-499.  |
| 2. | Marjolis 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. |
| 3. | Gamier G. Benign plasma cell erythroplasia. Br J Dermatol 1957: 69: 77. |
| 4. | Kmnar B. Sharma R. Rajgopalan M. Radothra BD. Plasma cell balanitis : clinical and histopathological features - response to circumcision. Genitourin Med 1995; 71: 32-34. |
| 5. | Montgomery D (ed.). Dermatopathology. London, Harper and Row.1967:2:988. |
| 6. | Murray JG. Fletcher MS. Yates-Bell AJ et al. Plasma cell balanitis of Zoon. Br J Urol 1986; 58: 689-691. |
| 7. | Souteyrand P. Wong E, MacDonald DM. Zoon's balanitis (balanitis circumscripta plasmacellularis). Br J Dermatol 1981; 105: 195-199. |
| 8. | Sonnex TS. Dawber RPR, Ryan TJ. Ralfs IG. Zoon's (plasma cell) balanitis : treatment by circumcision. Br J Dermatol 1982: 106: 585-588. |
| 9. | Zoon JJ. Balanoposthite chronique circonscrite benign a plasmocytes. Dermatologica 1952: 105:1. |
[Figure - 1], [Figure - 2]
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