Sandbox:Inflammatory dermatosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Vishal Devarkonda, M.B.B.S[2]

Synonyms and keywords:

Causes

	Clinical features	Diagnosis	Management
			Recommended regimen	Alternative regimens	Follow-up	Other recommendations
Lichen sclerosus	White patches on the glans, often with involvement of the prepuce. There may be haemorrhagic vesicles, purpura and rarely blisters and ulceration. Architectural changes include blunting of the coronal sulcus, phimosis or wasting of the prepuce, and meatal thickening and narrowing.	Diagnosis is with Biopsy Epidermis: Thickened epidermis which then becomes atrophic with follicular hyperkeratosis. Dermis: Dermal hyalinisation with loss of elastin fibers and underlying perivascular lymphocytic infiltrate
Lichen planus	purplish lesions, or supporting evidence of lichen planus lesions elsewhere on the body. This particularly includes the mouth in cases of erosive (penogingival) disease	Biospsy Irregular saw-toothed acanthosis, increased granular layer and basal cell liquefaction. Dermis: Band-like dermal infiltrate (mainly lymphocytic).
Zoon’s (plasma cell) balanitis	well-circumscribed orange-red glazed areas on the glans and the inside of the foreskin, with multiple pinpoint redder spots – ‘cayenne pepper spots.’ These are in a symmetrical distribution	Epidermis: Epidermis thickening which is followed by epidermal atrophy, at times with erosions. Dermis: Plasma cell infiltrate with haemosiderin and extravasated red blood cells.
Psoriasis	circumcised male psoriasis on the glans is similar to the appearance of the condition elsewhere, with red scaly plaques. uncircumcised scaling is lost and the patches appear red and glazed.	Biopsy: Parakeratosis and acanthosis with elongation of rete ridges. Collections of neutrophils in the epidermis may be present.
Circinate balanitis	Typical appearance: greyish white areas on the glans which coalesce to form ‘geographical’ areas with a white margin. It may be associated with other features of Reiter’s syndrome but can occur without.	.Biopsy: Epidermis: Spongiform pustules in the upper epidermis.
Eczema	Symptoms ranges from mild non-specific erythema to widespread oedema of the penis.	Biopsy: eczematous with spongiosis and non-specific inflammation.				Avoidance of precipitants – especially soaps.5 . Emollients – applied as required and used as a soap substitute.
Seborrhoeic dermatitis	Mild itch or redness (less likely to have scaling at this site)
Fixed drug eruption	Well demarcated and erythematous, but can be bullous with subsequent ulceration	Biopsy: Hydropic degeneration of the basal layer Epidermal detachment and necrosis with pigmentary incontinence.
Non-specific balanoposthitis	Chronic symptomatic presentation with relapses and remissions or persistence. No unifying diagnosis and poor response to a range of topical and oral treatments.		Circumcision is curative.