CLINICAL-FEATURES AND MANAGEMENT OF RECURRENT BALANITIS - ASSOCIATIONWITH ATOPY AND GENITAL WASHING

Objective-To evaluate clinical features and diagnostic investigations in patients with recurrent or unresponsive balanitis in order to insti tute rational management. Design-Forty-three patients presenting to a genitourinary medicine clinic with recurrent or persistent balanitis w ere studied. All patients were asked whether they had a history of ato pic illness and about their practice of genital washing. All patients were investigated by taking a swab specimen from the preputial area fo r bacterial and viral culture and 30 underwent biopsy of the affected skin. Follow-up was between three and six months. Setting-Outpatient g enitourinary medicine clinic, St Mary's Hospital, London, UK. Results- In 31 (72%) of the patients a diagnosis of irritant dermatitis was mad e. In comparison with the remaining patients, they had a greater lifet ime incidence of atopic illness and more frequent daily genital washin g with soap. For 28 (90%) of these patients, use of emollient creams a nd restriction of soap washing alone controlled symptoms satisfactoril y. For the remaining 12 patients, a variety of diagnoses were made. Bi opsy proved a well tolerated and diagnostic investigation, but the iso lation of microbial pathogens from preputial swabs was irrelevant to m anagement. Conclusion-A history of atopic illness and of the practice of penile washing are important aspects in the evaluation of patients with recurrent balanitis. Biopsy is an important investigation in the condition when it does not seem to be caused by irritant dermatitis.