Balanitis Cirumscripta Plasmacellularis

For 2 months, a 22-year-old uncircumcised man noticed an asymptomatic, erythematous, static lesion on the glans penis. He had applied an over-the-counter “jock-itch” ointment for 2 weeks but to no avail. The young man was otherwise healthy and denied having dysuria or a history of sexually transmitted disease.

The physical examination revealed a slightly raised, edematous, shiny, erythematous plaque with multiple peripheral pinpoint bright red spots on the glans. The lesion did not extend into the meatus or the coronal sulcus or onto the prepuce. Potassium hydroxide and Gram's stain examinations and Tzanck test results were negative. There was no lymphadenopathy. Results of a complete blood cell count were within normal limits. His rapid plasma reagin test and gonorrhea, chlamydia, and HIV laboratory test findings were negative.

A benign, inflammatory balanitis-balanitis circumscripta plasmacellularis or Zoon's erythroplasia-was diagnosed by Drs Daniel J. Schissel, MAJ, USA, MC, Jeffery Meffert, LTC, USAF, MC, and Mary Farley, MAJ, USA, MC, of the Brooke Army Medical Center, Fort Sam Houston, Tex. They comment that the lesion typically presents as a solitary, asymptomatic, well-circumscribed macule or plaque with a characteristic shiny, glazed, orange-tinted erythema with multiple pinpoint, brighter red macules at the periphery. In the uncircumcised patient, the lesion commonly involves the glans, but it may extend onto the coronal sulcus, prepuce, or shaft. The lesion can last from months to years without change.

The etiology of this condition is not understood. Chronic infection by Mycobacterium smegmatis has been implicated; heat, poor hygiene, and constant friction from the prepuce act as predisposing factors.¹ Topical corticosteroids and antifungal preparations are often employed but are invariably ineffective.

The morphologic differential diagnosis includes candidiasis, lichen planus, psoriasis, Reiter's disease, fixed drug eruption, herpes simplex, and secondary syphilis. Early lesions may be clinically impossible to differentiate from erythroplasia of Queyrat or squamous cell carcinoma of the glans.

Treatment of presumed Zoon's erythroplasia/balanitis consists of topical mupirocin ointment. If the lesion does not clear after a 3-week course of treatment, a biopsy is recommended to rule out a malignant process.^2,3

REFERENCES:1. Stern JK, Rosen T. Balanitis plasmacellulatis circumscripta (Zoon's balanitis plasmacellularis). Cutis. 1980;25:57-60.
2. English JC, Laws RA, Keogh GC, et al. Dermatoses of the glans penis and prepuce. J Am Acad Dermatol. 1998;37:1-24.
3. Fisher BK, Margesson LJ. Genital Skin Disorders: Diagnosis and Treatment. St Louis: Mosby; 1998:44.