Balanitis Xerotica Obliterans and Its Differential Diagnosis

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


J Am Board Fam Med. 1999;12(6) 

In This Article

Case Report

A 26-year-old man was referred to the dermatology clinic for evaluation of penile lesions. He stated that areas of lighter skin on the glans and foreskin had been increasing in size during the last 2 to 3 years and recounted a several year history of pruritus. Erections were associated with fissuring of the glans and shallow erosions along the foreskin. The patient was taking no medications, including laxatives or anti-inflammatory agents. The patient's medical history was noncontributory. His sexual history was negative for sexually transmitted diseases and anal receptive intercourse. He was currently involved in a heterosexual, monogamous relationship and did not use condoms. He had a lifetime history of fewer than four sexual partners. A review of symptoms was pertinent for a lack of headache, malaise, myalgias, arthralgias, or eye complaints. The patient's initial reason for seeking care was prompted by concerns of a possible herpes infection and the start of a new relationship.

On retraction of the foreskin, a discrete, white, slightly depressed 1.3-cm patch was visible on the left glans, which extended to the edge of the meatus. (Figure 1) The foreskin was thickened, and there were 2-mm to 3-mm atrophic, confluent, macules. No erosions, vesicles, hyperpigmented plaques, or inguinal adenopathy were observed.

Balanitis xerotica obliterans. Well-defined, hypopigmented patch on the distal glans. Sclerotic process extends to urethral meatus with mild erythema of urethral os. Multiple hypopigmented macules, coalescing into plaques, are present on retracted foreskin.

Histologic examination of a cutaneous biopsy of foreskin confirmed the diagnosis of balanitis xerotica obliterans. Therapy consisted of 0.05% clobetasol ointment applied to the glans and foreskin, initially twice daily for 3 weeks, then once every other day. The patient's symptoms of pruritus, fissuring, and erosions resolved within 7 days. A recommendation for circumcision was made, but the patient declined the procedure.


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