Balanitis Xerotica Obliterans and Its Differential Diagnosis

Isaac M. Neuhaus, and Robert A. Skidmore, MD,

J Am Board Fam Med. 1999;12(6)

Abstract and Introduction

Background: Balanitis xerotica obliterans is a subcategory of lichen sclerosus et atrophicus limited to the male genitalia and is associated with destructive inflammation, phimosis, urethral stenosis, and squamous cell carcinoma.
Methods: The medical literature was searched from 1983-1998 using key words balanitis, lichen, and sclerosis using the MEDLINE system.
Results and Conclusions: Balanitis xerotica obliterans can be distinguished from other genital dermatoses with similar characteristics through patient history, clinical findings, and laboratory evaluation. Tzanck smear and cutaneous biopsy, along with a rapid protein reagin test, will provide a definitive diagnosis. Treatment with high-dose topical corticosteroids relieves symptoms, and therapy focuses on prevention of disease progression.

Balanitis xerotica obliterans is a subcategory of lichen sclerosus et atrophicus limited to the male genitalia.^[1] It is associated with destructive inflammation, phimosis, urethral stenosis, and squamous cell carcinoma. Balanitis xerotica obliterans will often be a diagnostic challenge because of the broad differential diagnosis of genital dermatoses with similar characteristics.

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Table 1. Characteristics of the Differential Diagnosis of Balanitis Xerotica Obliterans.
Disease	Systemic Symptoms	Extragenital	Cause	Diagnosis
Balanitis xerotica obliterans	No	Occasionally	Unknown	Biopsy
Herpes simplex virus (HSV)	Fever, myalgia, headache, malaise	Yes	HSV type 2, HSV type 1 (less frequently)	Tzanck smear, immunofluorescence, viral culture, biopsy
Syphilis	Splenomegaly, fever, lymphadenopathy	Secondary: palms, soles, trunk, neck	Treponema pallidum	Dark-field microscopy, VDRL or rapid protein reagin followed by FTA Abs
Fixed drug eruption	No	Oral mucosa can be positive of negative	Drugs, phenolphthalein, sulfonamides, tetracycline, ampicillin, nonsteroidal anti-inflammatory medications	History and physical examination
Reiter syndrome	Arthritis, conjunctivitis, fever	Palms and soles	Unknown Association with HLA	Clinical findings
Vitiligo	No	Often generalized	Unknown	Biopsy
Erythroplasia of Queyrat	No	No	Possibly human papilloma virus	Biopsy

FTA Abs--treponemal antigen test specific for Treponema pallidum. HLA--human leukocyte antigen.

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Balanitis Xerotica Obliterans and Its Differential Diagnosis

Abstract and Introduction

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References

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