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Balanoposthitis by Aseem

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Short ppt on Balanoposthitis and how to reach a diagnosis of Non Specific Balanoposthitis by exclusion.

Short ppt on Balanoposthitis and how to reach a diagnosis of Non Specific Balanoposthitis by exclusion.

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  • 1. BALANOPOSTHITIS
  • 2. DEFINITION • Gk : ‘Balanos’ - Head of Penis / Glans Lat : ‘Posthe’ - Foreskin / Prepuce + ‘itis’ – inflammation Defined as the inflammation of the Glans Penis and mucosal surface of the Prepuce, commonly in uncircumcised males, with subpreputial discharge and phimosis. 2% Incidence
  • 3. AETIOLOGY • INFECTIONS Fungal Candida albicans (MC – 20%) Malassezia furfur (P. orbiculare) Anaerobic Organisms Corynebacterium diphtheriae Fusospirochaetes
  • 4. AETIOLOGY • INFECTIONS Spirochaetal Treponema Pallidum T. refrigens / phaegedenis / balanitidis / vincenti Viral HSV (20%) HPV Mycobacterial M. tuberculosis M. leprae
  • 5. AETIOLOGY • INFECTIONS Aerobic Org Gardenella Vaginalis Streptococcus sp S. aureus Calymmatobacterium granulomatis Neisseria gonorrhoeae Chlamydia trachomatis Hemophilus ducreyi Pseudomonas
  • 6. AETIOLOGY • INFECTIONS Protozoal Trichomonas vaginalis Entamoeba histolytica Parasitic Scabies Pediculosis Creeping eruptions / CLM
  • 7. AETIOLOGY • IRRITANTS / ALLERGENS Smegma Soaps Urine Condoms Spermicides Podophyllin / Topicals Lubricants
  • 8. AETIOLOGY • TRAUMATIC Post-coital / Post-masturbation Zip fastener laceration Frictional trauma Teeth bites Excoriations
  • 9. AETIOLOGY • FIXED DRUG ERUPTIONS Tetracyclines / Sulphonamides Carbamazepines Dapsone Salicylates Erythromycin Metronidazole Barbiturates
  • 10. AETIOLOGY PREMALIGNANT CONDITIONS Erythroplasia of Qeuyrat (Bowen’s dis) Leukoplakia Extramammary Paget’s MALIGNANT DISEASES SCC / BCC MELANOMAS
  • 11. AETIOLOGY • CUTANEOUS / MUCOCUTANEOUS DIS Pemphigus DH / EM / SJS / TEN LP / Psoriasis Behcet’s Disease Aphthae Porokeratosis of Mibelli Herpes Zoster Varicella Zoster
  • 12. AETIOLOGY • MISCELLANEOUS Circinate Balanitis Zoon’s Balanitis Balanitis Xerotica Obliterans (Lichen Sclerosus et Atrophicus) Pseudoepitheliomatous micaceous and keratotic balanitis of Civatte (PMKB) FB-induced (Beads / Calculi) Post Intravesical BCG (Granulomatous BP)
  • 13. CLINICAL FEATURES • Papules / Pustules or Vesicles (even Bullae) with Erosions • Prepucial Edema, Phimosis • Thick, foul smelling subpreputial discharge • Pain / Pruritis / Burning Micturition • Painful LAN • Extensive Ulceration • Phaegedena
  • 14. CLINICAL FEATURES • Frenal tears / Edema / Pain (Traumatic) • Vesicles / Bullae with Erosions (CD/FDE)
  • 15. CLINICAL FEATURES • Smooth erythematous scaly papules with satellite pustules (Superadded inf)with peeling of skin +/- Plaques of thrush / Maceration / Erosions (Candida albicans)
  • 16. CLINICAL FEATURES • Small Gray-White vesicles on erythematous base +/- Ulceration with Prostatitis / Urethritis (Trichomonas Vaginalis)
  • 17. CLINICAL FEATURES • Superficial Erosions with Purulent Urethral Discharge (Neisseria Gonorrhoea)
  • 18. CLINICAL FEATURES • Erosive indurated painless Chancre over Prepuce with Phimosis – Doughy inflitrate / Nodular Infiltrate / Diffuse Inflitrate) (Follman’s Balanitis of Syphilis)
  • 19. CLINICAL FEATURES • Multiple painful shallow non-indurated ulcers with undermined edges over prepuce / glans +/- Phimosis (Chancroid)
  • 20. CLINICAL FEATURES • Annular erythematous moist plaques with ulceration healing with fibrosis / scarring with preceding Oral Ulcers / Ophthalmic inv (Behcet’s Disease)
  • 21. CLINICAL FEATURES • Bright red micaceous scaly annular plaques with cutaneous / nail / joint inv (Penile Psoriasis)
  • 22. CLINICAL FEATURES • Painless, Serpiginous, geographic dermatitis of Glans (uncirc) and Hyperkeratotic plaques (Cir) (CIRCINATE BALANITIS of REITER’S DIS)
  • 23. CLINICAL FEATURES • Chronic inflamm followed by atrophic sclerosis, depigmentation, induration, phimosi s and Urethral Stricture (Lichen Sclerosus et Atrophicans / BXO)
  • 24. CLINICAL FEATURES • Chronic benign circumscribed plasma cell balanitis; shiny red velvety plaques with Cayenne Pepper stippling (ZB)
  • 25. COMPLICATIONS • • • • • • • • • • Recurrence / Chronicity Phimosis / Paraphimosis BXO Prepucial Adhesions Prepucial Perforation Phagaedena Scarring / pigmentation Meatal Sricture Lymphedema Neoplasm
  • 26. DIAGNOSIS • Detalied History taking / Clinical Examination • Confirm Diagnosis KOH MOUNT (CANDIDA) SUBPREPUTIAL SWAB for Culture (TRICH) GS / ZN STAIN (MIXED INF) PUS CULTURE / ABST (MIXED INF) DGI MICROSCOPY (SPIRO) TZANCK SMEAR (HSV) ACETOWHITE TEST (HPV) URETHRAL SWAB (GONO) PATCH TESTS (CD) SKIN BIOPSY
  • 27. DIAGNOSIS • LAB INV (SPECIFIC) HIV VDRL / RPR / TPI / FTA-ABS BS F/PP URINALYSIS / CULTURE CBC
  • 28. TREATMENT : GENERAL MEASURES SUBPREPUCIAL IRRIGATION NS / KMnO4 (1:10,000) / 1% Boric Acid 1% Lead Acetate / 0.6% MgSO4 CIRCUMCISION (Phimosis / ZB / Chronic / Intractable BP) TREATMENT OF SEXUAL PARTNER(S) MANAGEMENT OF SYSTEMIC DISEASE (HIV / DM / PSOR / BEHCET’S) PERSONAL HYGEINE
  • 29. TREATMENT MEASURES : SPECIFIC • ORAL and / or TOPICAL ANTIBIOTICS / ANTIFUNGALS / ANTIVIRALS / ANTHELMINTHICS • TOPICAL CORTICOSTEROIDS (PSOR / LP / FDE / ZB / BXO / CD) • TOPICAL 5-FU 5% (PMKBoC / Bowen’s) • MOHS MICROSURGERY • SURGICAL MGMT (MEATOPLASTYTOMY, DORSAL SLIT, CIRCUMCISION)
  • 30. THANK YOU

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