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Balanitis - Management
Basis for recommendation
These recommendations are based on expert advice from review articles [Alsterholm et al, 2008; Bhalani et al, 2008; Singh and Bunker, 2008].
Predisposing factors
- Poor hygiene, recurrent trauma, or exposure to irritants are common causes of balanitis; therefore, identifying and correcting these predisposing factors will reduce the risk of recurrence [Birley et al, 1993; Fornasa et al, 1994].
Sub-preputial swab
- A swab is useful to confirm, or exclude, an infectious cause of balanitis. Most people with balanitis presenting in primary care have mild non-specific dermatitis (with or without candidal colonization), which usually responds rapidly to empirical treatment. Therefore, it seems sensible to swab when balanitis is severe or recurrent, or not settling despite treatment with a combined topical corticosteroid and antifungal.
Excluding diabetes
- Diabetes predisposes to skin infections, especially candidal infections, and people with diabetes often develop severe infections. A survey of 138 men with candidal balanitis found one in 10 had diabetes that was previously undiagnosed. Therefore, excluding diabetes in men with severe or recurrent balanitis is recommended [Waugh, 1998].
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