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Balanitis - Management
How should I manage a child with balanitis?

  • Advise the child or the parents or carers to clean the penis with luke warm water and gently dry it.
    • No attempt should be made to retract the foreskin to clean under it, if it is still fixed.
    • Soap, bubble bath, or baby wipes should not be used.
    • If the child is still in nappies, these need to be changed frequently (see the CKS topic on Nappy rash).
  • For suspected non-specific dermatitis, with or without candidal or bacterial colonization:
    • Prescribe topical hydrocortisone 1% combined with an imidazole cream (clotrimazole 1%, miconazole 2%, or econazole 1%) once or twice a day until symptoms settle, or for up to 14 days.
    • If symptoms are not improving by 7 days:
      • Advise people to stop treatment with topical hydrocortisone.
      • Take a sub-preputial swab to exclude or confirm a fungal or bacterial infection, and treat accordingly.
  • For suspected irritant or allergic contact dermatitis:
    • Discontinue any suspected triggers (such as soap or creams).
    • Prescribe a mild topical hydrocortisone 1% cream or ointment once a day until symptoms settle, or for up to 14 days.
    • If symptoms are not improving by 7 days:
      • Advise people to stop treatment with topical hydrocortisone.
      • Take a sub-preputial swab to exclude or confirm a fungal or bacterial infection, and treat accordingly.
  • For suspected or confirmed candidal balanitis:
    • Prescribe an imidazole cream (clotrimazole 1%, econazole 1%, ketoconazole 2%, or miconazole 2%) twice a day until symptoms settle.
    • If inflammation is causing discomfort, consider prescribing hydrocortisone 1% cream or ointment for up to 14 days in addition to an antifungal.
    • If symptoms are not improving by 7 days:
      • Advise people to stop treatment with topical hydrocortisone.
      • Take a sub-preputial swab to exclude or confirm a fungal or bacterial infection, and treat accordingly.
  • For suspected or confirmed bacterial balanitis:
    • Prescribe oral flucloxacillin for 7 days.
    • Oral erythromycin or clarithromycin for 7 days are alternatives for boys who are allergic to penicillin (see Prescriptions).
    • Adjust treatment if indicated by sub-preputial swab results.
    • If inflammation is causing discomfort, consider prescribing hydrocortisone 1% cream or ointment for up to 14 days in addition to an antibiotic.
    • If symptoms are not improving by 7 days:
      • Advise people to stop treatment with topical hydrocortisone.
      • Take a sub-preputial swab to exclude or confirm a fungal or bacterial infection, and treat accordingly.

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