Copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.
Plasma cell balanitis, or Zoon balanitis (ZB), is a chronic, benign, inflammatory process usually involving the glans penis and the prepuce. Different treatments have been attempted with partial success.1
Topical formulations of the immunosuppressant macrolide tacrolimus have proved effective in atopic dermatitis, but the use of topical tacrolimus in other skin diseases has only been partially explored.2 - 4 We report 3 cases of ZB treated with tacrolimus ointment.
Relevant data are shown in the Table. All patients had shiny, smooth, red plaques on the glans and inner surface of the prepuce (Figure, A). In each case, histologic studies revealed a dense band of plasma-type cells. Previous treatment, consisting of a combination of corticosteroid and/or antimicrobial creams, plus oral antimycotic and/or corticosteroid medications, was replaced with twice-daily applications of 0.1% tacrolimus ointment or cream for 3 weeks. No irritation was experienced from topical tacrolimus. At the end of treatment no signs of inflammation were seen on the glans (Figure, B). In patient 3, the surface of the mucous prepuce became red for 5 days; this patient continued to apply tacrolimus cream twice daily for another 2 weeks and became asymptomatic.
Zoon balanitis. A, 2 Plaques with a shiny, smooth, red surface can be seen on the lateral aspects of the glans; B, there is no sign of inflammation after 3 weeks of treatment (patient 1).
We report 3 cases of ZB that responded well to treatment with topical tacrolimus. Topical tacrolimus is an effective means of controlling the signs and symptoms of diverse inflammatory mucous membrane and genital diseases such as erosive or ulcerative oral lichen planus, oral cicatricial pemphigoid, and anogenital lichen sclerosus, with no notable adverse effects.2 - 4 Topical tacrolimus has been applied in only 1 other disease with plasma cell involvement, with decreased induration of the plaques.4
The pathogenenis of ZB is still not understood, and we cannot explain the mechanism of action of tacrolimus. The most common adverse effects when using topical tacrolimus in the management of ulcerative/erosive oral lichen planus are a burning sensation at the site of application and transient taste disturbance.5 Although our experience is anecdotal, topical tacrolimus was well tolerated by all of our patients and they showed a good response. There may be a role for this treatment in the management of ZB. However, the study of a larger cohort is required to determine whether the improvement is related to the treatment.
Correspondence: Dr Santos-Juanes, Department of Dermatology II, Hospital Central de Asturias, C/Julian Clavería S/N, Asturias 33004, Spain (jocris@terra.com).
Financial Disclosure: None.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
Instructions
Comments are moderated and will appear on the site at the discretion of the Archives of Dermatology editors. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest* Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 13
Customize your page view by dragging & repositioning the boxes below.
and access these and other features:
Register Now
Enter your username and email address. We'll send you a reminder to the email address on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.