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Balanitis - Management
Basis for recommendation
These recommendations are based on expert advice from review articles [Orden et al, 1996; Schwartz and Rushton, 1996].
Non-specific dermatitis, with or without candidal or bacterial colonization
- A mild topical corticosteroid combined with an imidazole to treat the dermatitis (and any candidal infection) seems a logical approach if the balanitis is mild and clinical suspicion of a bacterial infection is low.
Candidal balanitis
- Topical imidazoles are recommended by experts based on their proven effectiveness in the treatment of candidiasis of the skin, toenails, and perineum in infants [Hay and Moore, 2004].
- CKS recommends continuing treatment until symptoms have settled, based on advice given in the UK national guideline on the management of balanoposthitis from the British Association for Sexual Health and HIV, for people older than 16 years of age [BASHH, 2008]. Although the licences for most antifungal drugs recommend continuing treatment for a short period of time after clinical cure, CKS found no evidence to support this approach in balanitis.
Bacterial balanitis
- An antibiotic with activity against group A beta-haemolytic streptococci and Staphylococcus aureus (bacteria that commonly cause bacterial balanitis) will usually result in rapid resolution of symptoms and eradication of the offending organism. CKS found no specific trial evidence for the use of antibiotics for balanitis.
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