CASE REPORT
A 62-year-old Asian male with a history of rheumatoid arthritis
presented to the clinic complaining of a red penile
rash. It had been present for approximately 8 years
and waxed in waned in terms of redness and area involved, but
slowly enlarged to cover more area. He denied any symptoms
associated with the rash including pain or tenderness, discharge,
or bleeding. Previous treatments included an unknown topical
steroid ointment, which only helped for a few months. He denied
a history of any new medications in relation to this rash and had
no new sexual contacts or high-risk behaviors.
On exam, on the glans of an uncircumcised penis there was a
diffuse, deep red, and erythematous patch. On the distal shaft
of the penis was a similar appearing patch sparing the coronal
sulcus with a “cayenne pepper†red/orange, speckled periphery.
A deep shave biopsy showed a superficially attenuated mucosal
surface with a dense inflammatory infiltrate in the dermis
composed predominantly of plasma cells mixed with lymphomononuclear
cells. Microorganism stains were negative.
DISCUSSION
Zoon’s balanitis is typically found in older, uncircumcised males
and can be asymptomatic, pruritic, or cause dysuria. The typical
appearance are erythematous, discrete, moist plaques with
a “cayenne pepper†speckled appearance and an orange hue
on the glans penis, and sometimes prepuce, which may display
“kissing lesions†on areas that is in direct contact with the lesions.
These may eventually erode and leave a “rusty stainâ€.1
Histologically, these have a dense lichenoid infiltrate in the upper
and mid dermis with abundant plasma cells.
The traditional teaching of Zoon’s balanitis is that it is generally a
benign, chronic, inflammatory process in uncircumcised males,
which is best treated by circumcision. There is a case report of
this condition occurring in a circumcised male2 and there are
many reports of it being treated medically rather than surgically.
Zoon’s balanitis is reported to have been treated successfully