Balanitis
Introduction
Introduction to balanitis The inflammation of the glans mucosa is called balanitis. The disease can be caused by various pathogen infections, local irritation and other factors. Foreskin balanitis refers to the inflammation of the inner skin of the foreskin and the head of the penis. A lipid substance secreted in the normal foreskin cavity. When the foreskin is too long or phimosis, such substances can accumulate into smegma to stimulate the foreskin and the penis head to cause foreskin balanitis. Foreskinitis caused by drug allergy is a delayed type of allergic reaction, which is quite common in clinical practice. It usually occurs 24 to 72 hours after administration. basic knowledge The proportion of sickness: 0.01% Susceptible people: male Mode of infection: some are contagious Complications: phimosis
Cause
Cause of balanitis
Causes:
It is an acute and chronic inflammation caused by various reasons, such as excessive prepuce, trauma, local physical factors and infection factors.
Pathogenesis
Local physical factors such as stimulation and infection factors cause acute and chronic inflammation of the glans mucosa.
Prevention
Balanitis prevention
Always clean the foreskin and penis head to keep the foreskin cavity clean and dry. If the foreskin is too long or phimosis, circumcision should be performed.
Complication
Balanitis complications Complications
Secondary phimosis; urethral stricture; anterior urethra stricture.
Symptom
Gallbladder symptoms common symptoms pustular glans ulcer epidermis keratogenic secretions spotted haemorrhagic herpes
The following are common:
1, acute superficial balanitis (acute superficial balanitis)
It is an acute inflammation of the glans, often caused by trauma, friction, soap, detergent and other local irritations. It is mainly characterized by local edematous erythema, erosive exudate, blistering and bullae in severe cases, and ulceration after secondary bacterial infection. There are purulent secretions, the above symptoms can be caused by local friction, poor foreskin turnover, accumulation of secretions, stimulation of wounds and increased inflammation, conscious pain and tenderness, local inflammation is significant, may be associated with mild systemic symptoms.
2, ring erosive balanitis (circinate erosive balanitis)
There are two types of clinical manifestations, one is the early manifestation of Reiter's disease. The other is persistent, recurrent balanitis with ring or multi-ring damage. The erythema at the beginning of the glans and foreskin is gradually enlarged and is ring-shaped or multi-ring. Later, the superficial ulcer surface is formed and the foreskin is turned over. Poor people due to local accumulation of secretions, often secondary infections make the symptoms worse, lose their ring characteristics and not easily distinguish from superficial ulcers.
3, Candida balanitis (candidal balanitis)
Candida balanitis can be primary or secondary, the latter often secondary to diabetic patients, after the elderly consumptive disease and antibiotics and hormone therapy, the clinical manifestations of erythema, smooth surface, slight edge off Scraps, and satellite-like distribution of herpes and small pustules, slowly expanding to the surrounding area, the boundary is generally clear, the groin can also be involved, the glans mucosa in the acute attack is edematous erythema, the boundary is unclear, there may be erosion, seepage Liquid, microscopic examination and culture of the lesion can be found Candida, repeated episodes of Candida balanitis, can cause the foreskin to dry, fibrosis and hardening changes.
4, plasma cell balanitis (plasma cell balanitis or plasma cell balanitis of zoon)
It is a chronic inflammation of the inside of the foreskin and the glans, with plasma cell infiltration, only a few clear inflammatory erythema, the surface is moist and shiny, sometimes accompanied by erosion and punctiform bleeding, looks like an anti-drying The film has a small spot like paprika on the surface. The pathological section shows atrophy of the epidermis, the stratum corneum and the granular layer disappear, a large number of plasma cells infiltrate in the dermal papilla, telangiectasia, and hemosiderin deposition.
5. Mica-like and keratotic pseudoepithelial balanitis (micaceous and keratotic pseudoepotheliomatous balanitis)
Occasionally in the elderly, there is a history of circumcision, which is characterized by the presence of silvery white mica-like scales on the glans, which are like psoriatic lesions, which can form cleft palate and ulcers, and the affected part gradually loses its elasticity. Long-term atrophic changes, histopathology showed epidermal hyperkeratosis, parakeratosis, pseudoepithelial-like proliferation, acanthosis hypertrophy, chronic inflammatory cell infiltration in the upper part of the dermis.
In addition, amoeba, trichomoniasis can also cause balanitis, amebic balanitis mostly from intestinal amebiasis, trichomonas balanitis has a history of sexual intercourse with trichomoniasis, etc., secretions can be Find the amoeba or trichomoniasis.
Examine
Check of balanitis
Inspection test
1. Candida balanitis: Candida can be found by microscopic examination and culture of the lesion.
2, amoeba, trichomoniasis infection can be found in the amoeba or trichomoniasis.
3, plasma cell balanitis: pathological section visible epidermal atrophy, stratum corneum and granular layer disappeared, a large number of plasma cells infiltrated in the dermal papilla, telangiectasia, hemosiderin deposition.
4, mica-like and keratinized pseudoepithelial balanitis: histopathology showed epidermal hyperkeratosis, parakeratosis, pseudoepithelial-like proliferation, acanthosis hypertrophy, chronic inflammatory cell infiltration in the upper part of the dermis.
Direct microscopy
Scrap the surface scales of the glans, coronal sulcus or foreskin at the penis as the specimen to be examined. The specimens to be inspected were made with 10% potassium hydroxide or physiological saline, and clusters of egg-shaped spores and pseudohyphae were observed under the microscope. If more pseudohyphae were found, it indicated that Candida was in the pathogenic stage.
Dyeing check
Gram staining, Congo red staining or PAS staining can also be used for microscopic examination. The positive rate is higher than that of direct microscopy. Gram staining, spores and pseudohyphae dyed in blue: Congo red and PAS staining, spores and pseudohyphae dyed red.
Isolation and culture
Candida culture can be performed in patients with negative smear tests. The test specimens were inoculated on Sabouraud medium under aseptic conditions. When inoculation, the test tube culture medium was cut obliquely, and each tube was inoculated with 2-3 spots, and each sample was inoculated with 2 tubes. The medium was incubated in a 37 ° C incubator for 24-48 hours, and a large number of milky white colonies were observed. A small number of colony smears were picked with the inoculation needle, and microscopic examination or microscopic examination was performed. A large number of spores were observed. Diagnosed as a Candida infection.
Candida antibody test
Candida albicans antibodies can be detected by immunodiffusion or latex coagulation.
Diagnosis
Balanitis diagnosis and identification
diagnosis
Mainly based on clinical manifestations, combined with pathological examination and laboratory tests, such as Candida infection, Candida can be found by direct microscopic examination and culture of the lesion. Amyba protozoa, taking secretions for smear examination, can find amoeba; pathological changes of plasma cell balanitis have diagnostic value.
Differential diagnosis
The disease should be differentiated from the drug-induced fixed drug eruption.
