Acne Inflammation Itching on the penis

Inflammation of the glans - balanitis

Inflammations of the glans are due to the associated itching and the pain that may occur an extremely unpleasant and annoying symptoms. Balanitis can be due to both infectious and non-infectious causes.

contents

• Inflammation of the glans - balanitis
• definition
• Symptoms of glansitis
• Causes of itching on the penis
• Inflammation of the glans by infections
• Non-infectious balanitis
• Cause skin diseases
• Chronic acorn inflammation
• diagnosis
• therapy
• Treatment of infectious balanitis
• Therapy of non-infectious glansitis
• Naturopathy with glans inflammation

definition

The term "balanitis" refers to an inflammation of the outer skin layers on the glans (glans penis) of the male genital or of the penis. If the inflammation also spreads to the inside of the foreskin, there is talk of a so-called "balanoposthitis".

An acorn-inflammation often causes pain and a strong itching. (Image: Kitty / fotolia.com)

Symptoms of glansitis

Patients generally complain of itching on the penis. Basically, the balanitis usually shows in the form of redness and superficial skin damage. The redness is often recognizable as spots on the glans, but sometimes the entire glans appears red. This can significantly increase in the course of inflammation. The damage to the skin is associated with an increased itching and possibly with pain or an unpleasant burning sensation.

The surface of the affected skin areas often appears slightly wet. In addition, depending on the cause of the balanitis, various other symptoms may occur. Examples include the formation of dander, a variegated change in the skin surface, punctual bleeding, purulent discharge in men or the development of ulcers.

In the case of balanoposthitis, the skin damage can also be observed in the area of ​​the foreskin. If the acne inflammation due to an infectious event or another underlying disease, numerous other concomitant symptoms may occur, which are each explained in more detail in connection with the causes.

Causes of itching on the penis

In the triggers of balanitis is initially distinguished between infectious and non-infectious causes. Infectious glans can be mycogenic, bacterial, viral and parasitic. The non-infectious glans inflammations arise, for example, by mechanical irritation of the skin, allergic reactions or chronic skin diseases. Following is a brief overview of the common triggers of balanitis.

Inflammation of the glans by infections

Infectious inflammations are usually characterized by a relatively acute course. They are caused by infestation with bacteria (for example from the genus of staphylococci and streptococci), viruses (for example, genital herpes viruses and human papillomavirus, HPV), fungi (usually yeast or Candida) or parasites (Trichomonas vaginalis).

Inadequate hygiene can significantly increase the risk of bacterial balanitis, as so-called smegma accumulates under the foreskin, which promotes the proliferation of germs. A weakened immune system, a disease of diabetes and foreskins (phimosis) also contribute to an increased risk of balanitis.

At the bacterial level, endemic germs are often the trigger. All pathogens of infectious glans inflammation can theoretically be passed on during sexual intercourse and cause corresponding diseases in the fellow man. Therefore, special care is needed here. Infectious inflammations of the glans may also be observed in connection with severe courses of urethritis. A typical feature in this case is usually a concomitant genital discharge. In addition to severe penile itching, urination pain and urinary output disorders can be part of the symptoms here.

The cause of balanitis, for example, may be an allergy to shower gel or body lotion. (Image: korobula / fotolia.com)

Non-infectious balanitis

The most common form of non-infectious glansitis is a so-called balanitis simplex, which is caused by irritation of the skin. These irritations can be caused for example by excessive sexual intercourse, but also by excessive genital hygiene. The already very thin skin of the glans is attacked or damaged by soap and toweling. Frequent repetition of the procedure results in inflammatory skin irritations.

These can be caused in rare cases by unsuitable underwear or the associated mechanical irritation. Allergic reactions, for example to shower gel, body lotions or condoms, can also be the cause of acne inflammation, these usually occurring immediately after use of the products.

A special form of non-infectious inflammation forms the so-called balanitis circinata. This is part of the symptom complex of Reiter's disease, which can occur in predisposed persons after a surviving genital or gastrointestinal infection. The symptoms include reactive arthritis, urethritis, balanitis, skin lesions and conjunctivitis. Not always do all the symptoms appear.

Cause skin diseases

Itching on the penis can occur as part of psoriasis, when the latter manifests on the glans penis.

This applies equally to the chronic skin disease Lichen sclerosus et atrophicans, which is known in the art as a trigger of balanitis xerotica obliterans. This form of glansitis is accompanied by the formation of white, porcelain-like patches and sclerotic lesions.
Due to the genital lichen sclerosus or the atrophy associated therewith (tissue damage), men often suffer from a foreskin constriction and possibly from a gluing of the foreskin and glans.

As a further chronic inflammatory skin disease, which may be the cause of glans inflammation, the so-called lichen lichen planus (lichen planus) may be mentioned. If this affects the genital area (which is rarely the case), whitish skin discoloration and painful open areas in the area of ​​the glans may appear.

If psoriasis occurs on the glans, it can cause a painful inflammation there. (Image: maksim28142 / fotolia.com)

Chronic acorn inflammation

The so-called Balanitis plasmacellularis (also known as Zoon's disease) forms a chronic form of acornitis, the causes of which are still not fully understood. Irregular reddish spots, with a moist, varnish-like surface, are typical signs of the disease. Also, there are more punctate hemorrhages on the affected skin areas of the glans. Foreskins and adhesions can also occur as part of the plasmacellular balanitis.

In the course of this epithelial atrophy occurs with loss of the stratum corneum and stratum granulosum. As a possible cause of the disease, for example, the accumulation of moisture under the foreskin (prepuce) is called. Heat, moisture and accumulated smegma are said to promote inflammation. Probably also special anaerobic bacteria play a role, which spread in the humid-warm environment. A slight incontinence is known as a risk factor for plasmacellular balanitis. Neglected genital hygiene can promote the development of chronic glansitis.

Extremely rare is the so-called balanitis gangraenosa, which is caused by a disease of Fournier's disease (also Fournier gangrene). The cause of this special form of necrotizing fasciitis (inflammation and atrophy of the subcutaneous tissue and fascia) is the pathological multiplication of aerobic and anaerobic bacteria in the corresponding tissue layers. The affected skin areas show a relatively sudden swelling, redness and blistering. In the further course follows a necrosis (dying) of the skin layers and underlying fascia. Not infrequently, the disease takes a fatal course.

diagnosis

Essential information on the diagnosis is provided by the anamnesis. The persons concerned are asked about the symptoms, their occurrence and possible connections with personal hygiene or hygiene. The doctors also inquire about known skin diseases and allergies that might be related. Since diabetes is considered a risk factor for balanitis, physicians usually also ask for an existing diabetes disease.

After a thorough anamnesis follows a first optical examination of the skin. In this context, it is also checked whether there is possibly a foreskin constriction. The laboratory examination of a urine sample and a skin swab from the area of ​​the glans, serves in infectious balanitis the pathogen detection. On the basis of the urine sample are often indications of a possibly concomitant urethritis.

If the above-mentioned examinations do not allow a clear diagnosis, the removal of a tissue sample (biopsy) remains the last option, in order to arrive at a reliable diagnosis and to detect possible cancers or precursors of a tumor. If it is suspected that the inflammation is the result of a general skin disease, the doctors are looking for other signs of these diseases in other parts of the body. Accompanying blood tests may also provide evidence of possible reactive arthritis or other systemic disease.

The examination of a urine sample may give evidence of infectious balanitis. (Image: Gerhard Seybert / fotolia.com)

therapy

At the beginning of the treatment, patients should generally be provided with detailed information about their condition, including the risk of transmission, in order to avoid the so-called ping-pong effect, with mutual infections of the sexual partners. In general, acne inflammation is recommended for thorough genital hygiene without the use of skin-irritating soap, perfume, shower or personal care. It should be remembered that an excess of cleaning can trigger the symptoms.

Treatment of infectious balanitis

If the glans inflammation is due to a bacterial infection, takes place with less serious courses of an external treatment with antibiotic creams and ointments. Severe forms of bacterial balanitis are treated with the systemic use of antibiotics.

Against the so-called Candida Balanitis (glans inflammations by yeasts) is a therapy with antimycotics, which are usually applied in the form of creams on the affected areas. In severe inflammation often antifungal ointments are used with cortisone content. Oral use of the antimycotics is possible if needed.

For the treatment of parasitic infections usually also orally applicable drugs are used, which have proven against the pathogen Trichomonas vaginalis and special antibiotics. In the case of virally induced glans inflammations, it is generally necessary to use externally applied antivirals.

Ultimately, however, the drug treatment approaches in the viral forms of balanitis are rather limited, since the corresponding preparations do not act comparably efficient, such as antibiotics in bacterial inflammation. For all forms of infectious inflammation applies that the sexual partners of the affected may also need to be treated accordingly, which is why they should be examined by a doctor.

Therapy of non-infectious glansitis

In the case of the particularly widespread balanitis simplex, externally applied, slightly cortisone-containing preparations are usually used to combat symptoms or inflammatory symptoms. At the same time, it is important to avoid re-irritation as much as possible in order to facilitate healing and to prevent recurrence of glans inflammation.

If balanitis is caused by Reiter's disease, orally administered, so-called non-steroidal anti-inflammatory drugs (NSAIDs) are used to alleviate the symptoms. In cases of severe forms of reactive arthritis, corticosteroids (corticosteroids) are also used. Chronic forms may require the use of immunosuppressants to control the symptoms of inflammation.

In case of psoriasis caused by psoriasis next to skin care products (emollients), more externally applied vitamin D preparations and optionally corticosteroids are used. Also, other, especially for the treatment of psoriasis approved drugs are available, which also show in psoriasis balanitis effect. In view of the complex aetiology (pathogenesis) of psoriasis, aspects such as nutrition or psyche are often taken into account as part of the treatment, as possible connections may exist here.

In an inflammation of the glans a thorough genital hygiene is particularly important. In addition to washing, this includes careful drying of the limb after showering. (Image: didecs / fotolia.com)

If the skin disease Lichen sclerosus triggers, the external application of highly effective glucocorticoids is usually resorted to. In particular, the anti-inflammatory and anti-allergic active ingredient clobetasol propionate is used here increasingly for the treatment of non-infectious, inflammatory skin disease. Fatty and moisturizing ointments should help to relieve the symptoms and slow down the course of the disease. Threatens in the course of the disease, a foreskin, circumcision may be necessary, even to avoid secondary infection.

If a lichen lichen planus (Lichen planus) at the bottom, the therapy is usually based on a similar procedure as in the case of lichen sclerosus: High-potency glucocorticoids are applied externally and in threatening complications is a foreskin incision.

In the case of a plasmacellular balanitis, circumcision is not uncommon in order to permanently prevent the pathological propagation of the germs under the foreskin. In general, it is important to eliminate the damp and warm environment here. Also, adequate genital hygiene is urgently required. After washing the limb, this should be dried very carefully, but thoroughly. Also, glucocorticoid preparations, applied once or twice daily, may help alleviate the symptoms and speed healing. However, these should be used only very limited in time. If necessary, antibacterial ointments can also be used.

The Balanitis gangraenosa is usually treated with a combination of antibiotic therapy and surgical removal of the affected tissue, which - depending on the severity of the disease - may be a very extensive procedure. If the necrotized tissue is not completely eliminated, it threatens a recurrence of inflammation and a large-scale skin loss. In the worst case, the disease can take a fatal course.

Naturopathy with glans inflammation

Naturopathy offers different approaches to the different forms of balanitis. According to the holistic view of the symptoms, factors such as the acid-base balance, the intestinal flora and the psychological situation of the affected persons are taken into account in the treatment.

In the case of infectious glans, measures that generally strengthen the immune system may be appropriate. Penis baths with, for example, kamillosan as well as herbal creams and ointments, with anti-inflammatory and antibacterial effects are also often part of naturopathic therapy.

Accompanying homeopathic remedies (for example, Arnica, Calcium fluoricum, Hepar sulfuris or Thuja) can be used against the inflammation, but their selection should be reserved for experienced therapists.

Although naturopathy offers a wide range of therapeutic approaches to the various forms of balanitis, those affected are not spared the treatment of severe antibiotics in severe cases and imminent complications. However, naturopathic procedures can often be used concomitantly or following the procedure and contribute to relief. (fp, nr, updated on 19.10.2017)
Specialist supervision: Barbara Schindewolf-Lensch (doctor)