Zoon's Balanitis, Male, 35, Uncircumcised

[regnof]

I have been diagnosed with Zoon's Balanitis, or Plasma Cell Balanitis.  I have been battling this inflammation for almost 2 years now.  My first occurrence of any penile inflammation was a month after I had unprotected sex, when I noticed a foul smelling substance (smegma) underneath my foreskin -- I am uncircumcised.  My primary physician told me it was a yeast infection, and that it can't be from sexual transmission since the yeast fungi can't be dormant for that long.  He recommended OTC clotrimazole.  I followed the treatment, and after a full week, went back to my primary to let him know that it wasn't working.  He sent me over to a dermatologist, and I was told that it was a fungal infection and to apply Lamisil, the OTC anti-fungal cream.  Within 3 days, the infection/inflammation cleared up and went away, or so I thought...

For 2 months, I was cleared of all symptoms.  Then after 3 days of hard drinking and insomnia because of work obligations and jet lag, I noticed the itchy irritation and smegma buildup once again.  I was out of the country at the time, but I knew exactly what to do - Lamisil.  Only this time, it didn't work.  When I came back stateside, my doctor tried everything that he could think of: OTC hydrocortizone cream/ointment, OTC antibiotic cream, oral antibiotics (Ciprofloxacin), anti-fungal cream (Lamisil, Clotrimazole), oral anti-fungal (Diflucan).  I went to another dermatologist, and he told me there's nothing he could do, and to apply hydrocortizone until judgment day; he also recommended circumcision.  I just tried Tacrolimus after researching extensively online, and that's failed me too.  I'm extremely depressed.  

The only relief I get is from OTC triple antibiotic from Walgreen, a Neosporin equivalent.  The active ingredients are Bacitracin Zinc, Neomycin Sulfate, and Polymyxin B sulfate.   If I apply this for about 3 days, once a day, I can stave off the balanitis for about a week, then the symptoms would slowly relapse, beginning with the presence of smegma, then the the redness and itchiness, and the transverse lesions at the base of the penile glans at the crease.  I've been doing this antibiotics on and off for about half a year now.  

Has anyone any ideas?  I'm miserable.  This thing has taken over my life.  Can someone please help!  I would really like to keep my foreskin.  Please, if anyone has any experience with overcoming this illness, short of circumcision, do contact me.

[BhumikaMD]

Hi,

You need o reconsult with your doctor or take a second opinion. Have any investigations been done?

You could read about the condition at the following links and let us know if you need any specific information.

http://www.emedicine.com/DERM/topic45.htm

and

http://en.wikipedia.org/wiki/Balanitis

Let us know about how you are doing and what your doctor advises.

Regards.

[regnof]

hi Dr. Bhumika,

Thank you very much for your reply.  I've seen 3 doctors already -- 2 primary and a well respected local dermatologist in Burbank, CA.  As for the websites, yes, I've researched extensively online regarding this subject and I had found and read those two.  

When you said "investigations," do you mean lab tests?  My primary doctor has tested me for diabetes, which was negative, and I've been tested for most STD's, which were all negative as well.  Just weeks ago, I was sent to get a urine culture.  Though initially tested positive with traces of bacteria, when retested again for bacteria culture, the results came back negative as well.  I suppose to conclusively confirm that my condition is indeed Zoon's Balanitis, or Plasma Cell Balanitis, I would need a skin biopsy.  Since I lack insurance at the moment, I am a little apprehensive  at the perceived cost, as well as the perceived pain of being "knifed."

The dermatologist advised that Zoon's Balanitis is idiopathic, and that it may persist or it may go away on its own, and to keep the area clean and use hydrocortisone as necessary.  I tried washing twice a day, morning and night with Cetaphil, a mild soap, but the condition would inevitably relapse in about 1-2 weeks if left unmedicated.  Once the irritation and itching become unbearable, I would apply the Walgreen triple antibiotic ointment for 3 days, then the inflammation would be kept at a manageable level for about a week before I reach for the antibiotic ointment again.  Not only am I curious to find out what active ingredient in the ointment is effective against the inflammation, more importantly, I wonder about the negative side affects, if any, of prolonged antibiotic use.  If the Balanitis react most favorably to an antibiotic ointment, could the underlying cause be bacterial?  If so, is there a class of oral antibiotics containing Bacitracin Zinc, Neomycin Sulfate, or Polymyxin B sulfate at a higher dosage that I should try?  Or is Ciprofloxacin a "catch all" antibiotics?  I did noticed when I was on Cipro that the Balanitis showed no improvement.

Thanks in advance for your advice.

[mariusz01]

Hi man. I'm 23 yeats old and come from Poland. I have the same problem. I'm suffering because of PCB since 2 years. And nothing helps me..I'm loosing any hope that it can be cured another way that circumcision. Currently I'm trying topical tacrolimus 0,1 as a cure (Protopic). Do you tried this?