Circinate Balanitis is a skin condition of reactive arthritis comprising a serpiginous ring-shaped patchy inflammation of the skin of the glans penis.
Circinate balanitis is one of the most common cutaneous manifestations of reactive arthritis.
At times Balanitis can also occur independently without arthritis.
The most commonly used treatment for Balanitis is topical corticosteroid therapy and topical calcineurin inhibitors have also been used successfully.
Balanitis Types
Usually, there are three types of balanitis:
Zoon’s balanitis:
Is also a primary type of balanitis. It is also known as balanitis circumscript a plasma cellular or plasma cell balanitis of Zoon.
It usually occurs in middle-aged people with an uncircumcised penis.
In this type of balanitis, there is a solitary, shiny, well-defined erythematous plaque on the glans penis.
Circinate balanitis:
This is a type of balanitis that is caused by reactive arthritis.
Reactive arthritis is a condition of joint deformity triggered by infection. In this type of balanitis, the inflammation is also accompanied by tiny sores on the head of the penis.
Pseudoepitheliomatous keratotic and micaceous balanitis:
This type of balanitis is a rare form of balanitis that affects people who are over 60 years of age group.
It usually manifests as scaly, wart-like bumps on the glans penis, in this type of balanitis there is shedding of the skin leading to cracks and itching.
Circinate Balanitis Causes
Balanitis is most often caused by a
- Fungal infections like a yeast infection
- Bacterial infections can also cause it
This happens commonly, due to improper hygiene, mostly because the foreskin can trap moisture, creating the perfect environment for fungus and bacteria to survive resulting in balanitis.
Balanitis occurs due to improper hygiene of the private area, not washing the male genital area well enough.
It can also occur by over washing as it leads to irritation and swelling.
On washing the genital area if the soap is not rinsed properly from the area after showering.
Using products like perfumes and dyes can also cause Balanitis.
Few causes of balanitis are
- Allergic reaction to latex condoms and spermicides
- Allergic reaction to certain medications, including some antibiotics and pain relievers.
- Sexually transmitted infections like Gonorrhea and trichomoniasis
- Scabies, an infestation of tiny skin mites.
- Certain medical conditions, including Diabetes and reactive arthritis
- Injuries on the tip of the penis i.e glans penis or foreskin of the penis
Circinate Balanitis – Symptoms
The common signs and symptoms of Circinate balanitis:
In the initial stages, the affected people usually suffer from pin-sized dots with a white plaque on them which frequently grows into flat, red areas, with hardened borders surrounding the white plaque.
There is no burning or itching, nor does it smell strange even though there are visible skin patches on the glans penis.
Swelling and redness of the head of the penis are the most common symptoms and often affect the foreskin.
Apart from the signs and symptoms mentioned above, according to cause balanitis might also lead to the following sign and symptoms:
- There is Soreness, pain, and irritation around the glans penis
- There is a tight, shiny foreskin of the penis
- Sometimes itching on the skin of the glans penis
- Unusual penile discharge can also occur
- There is Soreness on the head of the penis
- There is a thick, white discharge under the foreskin
- There can be a foul smell from the penis
- At times a patient can experience painful urination
- Swelling of the groin lymph nodes can be observed
Complications of Circinate balanitis
Lichen sclerosis:
It is called balanitis xerotica obliterans (BXO).
In lichen sclerosis, there are white, hard patches that form on the skin surface of the glans penis. These hard patches can interfere with the flow of urine and semen through the urethra.
Scar tissue:
Balanitis over a long period usually leads to scarring of the skin surface around the glans penis and makes the foreskin very tight to retract back over the glans causing pain.
Ulcerative lesions:
Balanitis leads to painful sores and blisters that ulcerate and bleed, and eventually cause scarring of the affected area.
Open sores increase the risk of infection by bacteria and viruses into the body and can cause secondary infections leading to urinary tract infections.
Increased risk of cancer:
Chronic persistent inflammation of the glans penis can increase the chances of several types of cancers.
According to a few researchers they claim that balanitis, posthitis, BXO, and phimosis usually are associated with a higher risk of penile cancer.
Early and correct treatment of balanitis and any underlying causes or infections can significantly reduce the chances of complications and improve the outlook of treatment to be planned by the doctor.
Risk Factors For Circinate balanitis
The male population at any age can develop balanitis, but those at higher risk are children under the age of 4 and uncircumcised, middle-aged adults.
People who have phimosis -a tight foreskin, that doesn’t retract back over the penis also have an increased risk of contracting balanitis.
The foreskin loosens and becomes easier to retract with age. This usually happens by around 5 years of age.
Diagnosis of Circinate balanitis
Doctors will usually make a diagnosis of Circinate balanitis with a medical history, occupational history, and physical exam.
Balanitis can usually be diagnosed during a physical examination because most of its symptoms are visible.
Other tests are done to determine the cause. The tests may vary depending on symptoms.
These tests include:
- A swab is taken of the urethral opening to check for STIs and other infections
- Urine analysis can be done to check for signs of infection or diabetes.
- A blood test can be suggested to check for signs of infections or diabetes.
- A skin scraping of the sample to examine for mites under a microscope.
Circinate balanitis Management
Balanitis treatment usually begins with improving the hygiene of the genitals by washing and drying under the foreskin.
The doctor may advise on avoiding the use of hygiene products that contain potential irritants, like perfumes, soaps, and other lotion used by the patient.
If the doctor finds out that the balanitis is caused by an allergic reaction to certain products or medications, your doctor can help in finding a few suitable alternatives that are non-allergic to the patient.
For example, different types of medication or latex-free and spermicide-free barrier methods.
Few treatments can be used to relieve the inflammation and treat the underlying cause of balanitis.
If sexually transmitted infections are the reason then the infection is promptly treated with suitable bacteria.
They include the use of various topical creams and medications for underlying causes of balanitis, it also includes some changes in daily habits.
Anti-Fungal creams:
Creams, like clotrimazole or miconazole, will be prescribed if the condition is caused by a yeast infection.
Anti-itch creams:
Over-the-counter and prescription-based anti-itch creams can be used, they will relieve symptoms like itching and redness.
Steroid creams:
Corticosteroid-based creams will help to relieve inflammation and itching.
Antibiotics:
If Balanitis is caused by an STI, antibiotics may be prescribed. The type of antibiotic and duration will depend on which STI the patient has.
Diabetes treatment:
If the patient has diabetes, the doctor will recommend a treatment plan to manage it. It will involve a combination of medication and lifestyle modifications to control blood sugar levels.
Circumcision:
If a patient is developing recurrent balanitis symptoms or phimosis, the doctor might recommend circumcision to remove the foreskin and prevent future symptoms and complications.
Balanitis is often as simple as practicing proper hygiene so that you avoid irritating the skin and prevent the buildup of excess moisture and bacteria under the foreskin.
Precautions to be followed at home:
One should take bath regularly using unscented, mild soap, making sure to clean the area under your foreskin and dry the skin thoroughly by gently patting the skin dry — not rubbing the skin.
Avoid using chemicals on and around the male genitals, such as soaps and detergents, shower gels, or lotions containing dyes and perfumes.
Spermicides should also be avoided if you’ve reacted to them.
Use condoms or other barrier methods when one is engaged in sexual activity and get tested for sexually transmitted infections regularly.
Best Homeopathic Medicines for Circinate balanitis
1. Apis mellifica -For balanitis with the stinging type of pain
Symptoms
Apis is a great remedy especially when balanitis is with marked inflammation and swelling of the glans penis.
It is indicated when the affected area is swollen red and inflamed with severe burning and stinging type of pain.
The area feels bruised and sore, and the person tries to avoid being touched, because of the pain.
It is indicated when the urine is scanty frequent and painful with sudden urging to urinate
It is indicated when the patient is thirstless, with a fiery red tongue and baglike puffy swelling under the eyes.
30 CH Potency,4 globules three times a day is used. Gradually, one can increase the potency depending upon the case’s progress.
2) Mercurius solibulis-For balanitis from suppressed gonorrhea
Symptoms
Merc sol is indicated for balanitis where there is visible swelling and painful sensitivity of the glans and the prepuce.
It is indicated when balanitis results after suppressed gonorrhea, there are small vesicles that are on the glans and prepuce.
There may be oozing of fluid from these vesicles along with a burning sensation.
It is indicated when there is a thin milk-like discharge under the glans penis, with an offensive smell.
There is severe burning during urination even though the patient is thirsty craving a large quantity of cold water.
The area often is red and swollen, and the overlying skin feels hot.
It is indicated when all the complaints are aggravated at night, damp weather, warm room, and a warm bed.
200 CH Potency,4-8 globules daily ones are used. Gradually, one can increase the potency depending upon the case’s progress.
3)Nitric acid -For Balanitis with ulcers
Nitric acid is used for the treatment of balanitis where there are reddish spots that appear on the glans along with moisture.
There is foul, smelling moist discharge from the glans and small pimples may appear on the glans penis.
It is indicated when there is splinter-like pain in the ulcers with cracks and severe pricking.
It is indicated when the affected area is inflamed and swollen with soreness making it difficult to pass urine.
There are burning, sticking, or tearing pains that may appear in the foreskin along with the presence of itchy vesicles.
It is indicated when all the complaints are aggravated at evening and mid-night, change of temperature or weather.
Potency & Dosage
30 CH Potency,4 globules three times a day is used. Gradually, one can increase the potency depending upon the case’s progress.
4) Caladium-For Inflammatory red patches in balanitis
Symptoms
It is a great remedy for balanitis with marked redness of glans.
It is indicated in balanitis when the glans are covered with reddish spots and there is marked dryness.
It is very useful for the foreskin which is swollen and sore, especially along the margins.
There is biting pain while urinating.
Potency & Dosage
30 CH Potency,4 globules three times a day is used. Gradually, one can increase the potency depending upon the case’s progress.
5)Rhus Toxicodendron – For balanitis with shooting type of pain
Symptoms
Rhus Tox is helpful in treatment for balanitis when there is dark red swelling of the glans and prepuce which is attended with a lot of shooting type of pain.
There is an itching and stinging sensation on the prepuce and moist vesicles on the glans penis.
It is indicated for balanitis with itching vesicular ulcers, itching worse at night, in cold wet weather.
It is indicated when there is pain and inflammation, balanitis with reactive arthritis may come on suddenly, and often shift around.
It is highly indicated when the patient is restless both mentally and physically, day and night, moves around continuously, and cannot sit still in one place.
30 CH Potency,4 globules three times a day is used. Gradually, one can increase the potency depending upon the case’s progress.
6)Sulphur – For Balanitis with itching and burning
Symptoms
Sulphur is useful for balanitis where there is marked itching and burning on the glans and prepuce.
It is indicated when there is swelling and redness in glans and prepuce with the discharge of fetid pus.
It is indicated when there is abnormal craving for sweet food, the skin area affected appears dirty, with a fetid smell, still, the patient thinks he is neat and clean.
It is indicated when there is offensive sweat which is present around the genitals in most cases with severe itching.
There is the copious secretion of fetid smegma may be present.
Potency & Dosage
30 CH Potency,4 globules three times a day is used. Gradually, one can increase the potency depending upon the case’s progress.
7) Rhododendron -For balanitis with distension of glans
Rhododendron is useful in cases of balanitis that occur along with throbbing and shooting pain under the glans penis.
It is indicated when there is crushing pain felt in the glans penis with swollen and enormously distended glans penis like a bladder.
It is indicated in cases where there is slight discharge from the glans penis.
Potency & Dosage
30 CH Potency,4 globules three times a day is used. Gradually, one can increase the potency depending upon the case’s progress.
8) Cinnabaris:-For Balanitis due to allergic factors
It is a wonderful remedy for Balanitis where there is itching attended with redness and swelling of the glans and prepuce.
It is indicated when there is fetid, yellow-green discharge under the prepuce with severe itching.
Potency & Dosage
30 CH Potency,4 globules three times a day is used. Gradually, one can increase the potency depending upon the case’s progress.
9)Caladium -For Balanitis with reddish spots on the glans
It is indicated in cases of balanitis with marked redness of the glans penis. The glans penis is covered with reddish spots all over, and there is marked dryness causing severe itching.
The foreskin is also swollen and sore, especially along the margins of the patches.
Biting pain while urinating is a marked feature in cases needing Caladium.
Potency & Dosage
30 CH Potency,4 globules three times a day is used. External application of ointment along with internal medicine is advisable.
10) Cantharis -For Balanitis due to urinary tract infection
Symptoms
Cantharis is used for Balanitis with painful urination.
It is indicated when the glans is intensely swollen and is very painful to pressure.
It is a useful remedy when the balanitis is accompanied by severe pain, burning, and smarting on passing urine that may continue even after urination.
Sometimes cutting pains appear on urinating.
The Urine may be scanty with frequent urging and violent pain in the glans that may precede urination.
Potency & Dosage
30 CH Potency,4 globules three times a day is used. Gradually, one can increase the potency depending upon the case’s progress.
Remember that homeopathic remedies are prescribed based on individual symptoms and characteristics. It’s crucial to consult with a qualified homeopath for proper evaluation and personalized treatment. Homeopathy focuses on treating the whole person, so a detailed case study is necessary to select the most appropriate remedy.
Homeopathic medicines should be taken only when prescribed by a homeopathic physician. Self-medication may aggravate the original conditions.