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Balanoposthitis in a child: symptoms, treatment

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Balanoposthitis in a child is a disease that almost every male member suffers in childhood. It is an inflammation of the glans penis and part of the foreskin. It is characteristic that balanoposthitis occurs in children 2-3 times more often than in adult males. The disease is directly related to the narrowing of the foreskin, which prevents proper cleaning of the urethra and contributes to the development of local infection.



The reasons

It is known that in the preschool years, many boys suffer from physiological phimosis, which by a maximum of eleven years is resolved naturally. At this age, the foreskin is already beginning to easily separate from the glans penis. Well, until that time, such physiological phimosis significantly complicates the personal hygiene of boys, and the pollution accumulated in the skin folds, and lead to the development of such problems.

The main pathogenic factor is infection of smegma, which is the secret of preputial glands and accumulates in the preputial sac. It is a favorable breeding ground for various pathogenic bacteria. The causative agents of this disease can be streptococci, E. coli, staphylococcus, fungi. The factors that provoke its development are as follows:

  • violation of personal hygiene;
  • high urine sugar content;
  • narrowness of the foreskin;
  • wearing too tight underwear;
  • improper selection of diapers for infants;
  • the use of too aggressive detergents for washing underwear;
  • too often the use of soap or other means when washing the foreskin.

The stasis of the contents of the skin cover, the accumulation of remnant urine in it - these are the immediate causes of the disease. The high sugar content in the urine of diabetic boys also often causes balanoposthitis. Often, the inflammation of the outer genital area of ​​the boys is triggered by rubbing with too close underwear.

Only sometimes the disease occurs as a complication of an infectious disease.

Types of disease

The disease can occur in the form of balanitis, which affects only the head of the penis, and postitis, which covers only the foreskin. Most often, the inflammatory process is observed in both parts of the penis and proceeds in the form of balanoposthitis.

There is an acute form of the disease, which lasts less than 3 months, and chronic, which lasts a longer period. In addition, both of these forms are divided into several varieties. Thus, the acute form of the disease includes:

  • erosive balanoposthitis;
  • simple balanoposthitis;
  • gangrenous.

The erosive form is characterized by the presence of ulcers and redness on the head of the penis. With a simple balanopostite, the hallmark is the thinning of the glans penis and its foreskin. This leads to burning, cramps and other painful sensations. This form results from exposure to the delicate skin of the foreskin of irritants of chemical, bacterial, fungal or mechanical origin.

The most severe form is gangrenous. In her case, the patient has ulcers with purulent contents, severe pain and swelling of the affected tissues, as well as an increase in temperature.

Symptoms of balanoposthitis in a child

Acute illness can begin completely suddenly. Balanoposthitis in a child is characterized by a group of basic symptoms, some of which occur regardless of the form of the disease, and the rest is inherent only in certain types of the disease. So, it manifests itself with the following symptoms:

  • redness at the site of inflammation;
  • sponginess of the skin;
  • swelling of the head and foreskin;
  • the appearance of sero-purulent discharge;
  • genital itching;
  • enlarged regional lymph nodes;
  • the occurrence of erosion and flaking of the skin.

Recent complaints appear with the progression of the disease, when the initial symptoms were ignored. Quite often, in the acute form of balanoposthitis in children, the temperature rises to subfebrile numbers. The child becomes moody and restless. If the disease broke out in infancy, when the baby can not yet talk about his complaints, it is worth noting that he cries when he touches the penis and urinates.

Diaper rash, rashes, cracks in the mucous membranes of the penis are also frequent concomitant manifestations of this disease.

Medical examination in addition to external redness and swelling of the head of the penis reveals whole deposits of smegma, which when exposed to the head are found under the inner petals of the foreskin and have an unpleasant smell.

Often this disease ends spontaneously: under the influence of bacteria, stagnant smegma dilutes and is washed out with sterile urine. But it is not always the end of the pathological process that is so favorable and often special treatment is required.

Treatment of acute balanoposthitis in a child

In the early stages of the disease, its treatment is not difficult. Be sure to consult a pediatric urologist or surgeon. Usually, hospitalization is not required, and the problem is completely solved at home.

The following therapeutic measures are mainly used:

  • baths with a solution of potassium permanganate or furatsilina;
  • the imposition of gauze lotions with antiseptic;
  • the use of medicinal powders.

To perform the bath does not need any baths or pots. It is enough to dilute the treatment solution in some small container and lower the diseased organ there. In the first 2-3 days from the onset of the disease to perform such a procedure preferably every 2 hours. A gauze bandage moistened with an antiseptic or antibacterial ointment can be applied overnight. But you should know that after water treatment procedures, the head of the penis should be gently dried with gauze or cotton, and only then apply an antiseptic.

Ointment "Levomekol" has a wide spectrum of antibacterial action, therefore it is often prescribed for balanoposthitis in the form of applications. In more complex cases, it is introduced into the preputium using a syringe. It is useful for babies to use powder with talc-tannin. Such measures are carried out until the complete disappearance of symptoms, and then only a more thorough observance of the rules of hygiene is required. Usually, in the acute form of uncomplicated balanoposthitis in children, it takes 2 to 5 days to treat.

For severe pain, the doctor prescribes a child to take non-steroidal anti-inflammatory drugs, such as ibuprofen.

If there is a suspicion of the presence of infection, a smear is taken from under the foreskin, which is examined for the presence of pathogens and their sensitivity to various antibacterial drugs. Then, based on the resulting information, prescribe a specific drug therapy. Usually used such tools as Nitroxolin, Erythromycin, Biseptol.

If the fungal nature of the disease is detected, then anti-mycotic ointments are used, for example, Clotrimazole, and the antifungal drug Fluconazole is usually prescribed. In severe cases, antibacterial and antifungal therapy can be carried out orally or intravenously.

Chronic balanoposthitis

Chronic balanoposthitis develops when treatment of an acute illness has not been completed. This form lasts for months, subsiding a little during the period of treatment and again becoming aggravated after its termination. Often it occurs when parents are trying to open the baby's foreskin forcibly. Chronic balanoposthitis can occur in the following forms:

  • ulcer-hypertrophic, manifested as a long time non-healing ulcers, accompanied by redness and soreness;
  • adhesive balanoposthitis, the symptoms of which are manifested by bloody wounds and characteristic secretions.

General symptoms with several others, not so sharp, but not for a long time disappearing:

  • itching in the foreskin area;
  • painful sensations;
  • slight hyperemia and swelling of the glans penis;
  • whitish discharge.

Chronic balanoposthitis is almost not treatable. After several relapses, as a rule, surgery is proposed to cut off the foreskin. It is carried out after the subsidence of inflammation, after its implementation, all manifestations and recurrences of the disease usually disappear. In addition, surgery eliminates the child from such problems as phimosis and paraphimosis in the future. A circumcision is recommended even for infants.

Traditional methods of treatment

It is useful in the treatment of children's balanoposthitis resort to the means of traditional medicine. Trays of antiseptic solutions while alternating with trays of infusions of herbs - chamomile, yarrow, sage, St. John's wort. Infusions are prepared at the rate of 1 tablespoon of herbs per cup of boiling water, incubated for about 30 minutes, then filtered. They can also be used to perform compresses.

When balanopostite in a child chamomile compresses are recommended, prepared according to a slightly different recipe: 3 tablespoons of boiling water are mixed with the same amount of pharmaceutical chamomile flowers. After cooling the resulting slurry, it is applied to a piece of gauze and applied to the affected area.

As an anti-inflammatory agent, you can use fresh aloe leaves, which are applied to the sore spot twice a day after completing the next bath. Before that, the leaves need to be cut off the spines, on one side to remove the skin and slightly knead.

Calendula infused with olive oil has a good anti-inflammatory and wound-healing effect. To prepare this infusion, 2 teaspoons of dried herbs of calendula are poured with half a glass of olive oil. Insist means in a warm place, occasionally shaking, for 3 weeks. For therapeutic purposes, put on purulent and inflamed areas.

Complications

It would seem that a small local inflammation on the penis of a child cannot threaten him with anything serious. But this is not at all the case. Balanoposthitis without proper treatment can lead to serious complications:

  • infection from the glans head can go to the urethra and lead to urinary tract infections;
  • prolonged inflammation of the foreskin can cause the formation of cicatricial phimosis;
  • in the absence of timely treatment, an ulcer form of the disease may occur, accompanied by the appearance of numerous small sores;
  • a prolonged inflammatory process leads to atrophy of the receptor apparatus and a decrease in the sensitivity of the glans penis, which in the future may adversely affect the potency.

The most unpleasant consequences are the development of paraphimosis and the gangrenous form of the disease.

Prevention

In order not to get sick with balanoposthitis, one should carefully follow the rules of personal hygiene and avoid accumulations of dirt in the folds of the genitals. To do this, it is recommended to strip and wash the glans head without soap every day, once a day. It is also advisable to wash the boy after each stool. It is important to change diapers in a very small way, regularly, especially for the slightest signs of irritation, to use baby powder or cream.

It is important for individuals who are caring for a child to know that under no circumstances should the foreskin of the baby be opened.

For boys of all ages, it is important to choose the right underwear - it should be from natural materials and not have rough seams in front.

Special precautions should be taken by those suffering from phimosis, diabetes, urethritis or hepatitis, i.e. diseases that in most cases are accompanied by balanoposthitis.


| 17 May 2015 | | 2 194 | Children's diseases
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Hemant verma: I am facing problem in pulling foreskin back due to dryness in side the foreskin, also feeling itching many times a restless. So I am using DERMIKEN OC but it works only 12-24 hrs. When I wash or clean it same dryness or pulling foreskin back happens again. Please tell me what to do ?? Thank you.

Remy: In case of (commensal) bacterial (no std) balanitis, which doesn’t respond to miconazol/antifungi (but responds to azytromycin), washing daily with a cheap/simple liquid showersoap (not too much ingredients) and in case of active balanitis itching/redness using jodium (povidon jodium) for max 3/5 days under the foreskin. (1 to 3 times a day) helped so much.

Доктор Артур: Balanitis Treatment & Management - short recommendations https://www.medjojo.com/2019/08/balanitisbalanoposthitis-diagnosis-and.html

Доктор Артур: Hygiene measures and empiric treatment — Management of balanitis without an identifiable cause is initially focused on implementation of local hygiene measures. In addition, empiric treatment for candidal infection and/or noninfectious dermatitis is warranted in some patients (algorithm 1). Attention to genital hygiene is the most important approach for most men with balanitis. Retraction of the foreskin with thorough genital cleansing can be both preventive and therapeutic. Twice-daily bathing of the affected area with saline solution should be encouraged [22,26]. If a contact dermatitis is suspected, use of soap may cause further irritation and should be avoided [36]. A delicate balance must be established between overly aggressive and inadequate hygiene measures. Overuse of detergents, soaps, perfumes, condoms, and other chemicals (spermicidal agents, petroleum jelly), similar to poor hygiene, can also result in inflammation to the skin of the glans/foreskin. In addition, dermatitis can result from irritation secondary to the shearing effects of clothing. In uncircumcised males, nonspecific balanitis may respond to saline solution bathing alone. In circumcised males and in uncircumcised males who do not respond to saline solution bathing, we suggest empiric treatment for candidal infection with clotrimazole 1% cream or miconazole 2% cream twice daily for seven days (see 'Candidal infection' below). For those who have no improvement on antifungal therapy, we suggest a trial of hydrocortisone 1% cream twice daily for seven days for nonspecific dermatitis. Patients with nonspecific balanitis who do not respond to local hygiene measures with or without topical antifungal and hydrocortisone therapies should be referred for dermatologic or urologic consultation for consideration of biopsy to evaluate for specific dermatologic causes and/or to rule out premalignant disease. Directed treatment for identifiable causes Candidal infection — For most patients, treatment includes the use of topical antifungal agents, usually for one to three weeks. First-line therapy includes a topical imidazole, either clotrimazole 1% or miconazole 2%, each applied twice daily [22]. Nystatin cream (100,000 units/g) can be used in patients allergic to imidazoles. For patients who have severe symptoms, options are a single dose of oral fluconazole 150 mg [37] or the combination of a topical imidazole and hydrocortisone 1% cream twice daily. These recommendations are supported by evidence from treatment of cutaneous candidiasis in general. Some patients may be interested in taking lactobacillus-containing yogurt as an attempt to decrease candidal colonization. Although there are no studies of lactobacillus in the treatment or prevention of candidal balanitis, given that it decreases candidal colonization of the rectum and vagina among women, there is a theoretical basis for its utility [38,39]. We do not suggest alternative therapies with phytogenic agents including garlic, calendula, and goldenseal since there are no reliable data showing their effectiveness. Female sexual partners of men with balanitis should be offered testing for candida or empiric treatment to reduce the likelihood or reinfection [22]. (See "Candida vulvovaginitis: Treatment", section on 'Recurrent treatment'.) Less common etiologies — If other specific etiologies are identified, directed therapy is warranted. Management generally consists of topical antibiotics for bacterial infections, topical steroid cream for dermatologic conditions, and potential ablation or excision of premalignant lesions. ●Bacterial and other infections – Specific pathogens are not usually identified, and treatment choices are generally empiric. For suspected anaerobic infection, we suggest topical metronidazole 0.75% applied twice daily for seven days; oral metronidazole (500 mg twice daily for seven days) may be necessary for more severe cases [22]. Oral amoxicillin-clavulanate or clindamycin topical cream are alternative regimens. For suspected streptococcal or staphylococcal infection, we suggest mupirocin cream applied three times daily for 7 to 14 days; oral dicloxacillin (500 mg four times daily for seven days) or cephalexin (500 mg four times daily for seven days) may be necessary for more severe cases. Circumcision or dorsal slit surgery should be strongly considered in patients with a history of recurrent infectious balanitis but not during active infection. Management of trichomonas, herpes simplex virus (HSV) infection, syphilis, scabies, and Mycoplasma genitalium infection is discussed separately. (See "Treatment of genital herpes simplex virus infection" and "Syphilis: Treatment and monitoring", section on 'Treatment of early syphilis' and "Mycoplasma genitalium infection in men and women", section on 'Treatment' and "Scabies: Management".) ●Dermatologic conditions •Psoriasis – Psoriasis is managed with a moderate potency topical steroid cream (table 3) and emollients. (See "Treatment of psoriasis in adults".) •Eczema – Eczema is managed with hydrocortisone 1% cream applied twice daily. (See "Treatment of atopic dermatitis (eczema)".) •Lichen planus – Lichen planus is managed with high- to super high-potency topical steroid cream (table 3); topical or oral cyclosporin, topical calcineurin inhibitor, or circumcision may be recommended in refractory cases. (See "Lichen planus", section on 'Treatment'.) •Lichen sclerosus – The recommended treatment is daily high-potency topical corticosteroid (eg, clobetasol propionate 0.05% cream or ointment) [40]. Therapy is generally administered until remission and then transitioned to weekly intermittent use to maintain the remission. Acitretin is a systemic retinoid that is effective as alternative therapy for balanitis xerotica obliterans (BXO) resistant to topical glucocorticoids [41]. However, acitretin has several adverse effects including cheilitis, alopecia, and abnormal liver function tests. Circumcision is indicated in the event of phimosis [42], and meatoplasty or urethroplasty is warranted if meatal stenosis is present. Even after surgery, the skin condition still requires treatment. Follow-up should occur at least annually after remission has been achieved. •Plasma cell (Zoon’s) balanitis – Treatment regimens include topical steroid cream or carbon dioxide laser [43,44]. The lesions may resolve with circumcision [43]. •Contact dermatitis – Treatment includes local cleansing and avoidance of the precipitating agent(s). In the place of soaps, aqueous cream is encouraged to soften and soothe the skin surface [36]. (See "Irritant contact dermatitis in adults", section on 'Management'.) ●Premalignant conditions •Bowenoid papulosis – Treatment consists of imiquimod 5% cream or laser resection [22]. •Carcinoma in situ – Surgical excision, topical chemotherapeutic therapy, or laser excision are reasonable treatment options [22]. Mohs surgery is also an acceptable treatment. ●Miscellaneous conditions •Reactive arthritis – The suggested treatment of circinate balanitis is hydrocortisone 1% cream applied twice daily for relief of symptoms. In addition, any concurrent infection should be treated. Systemic corticosteroid treatment is required infrequently. (See "Reactive arthritis", section on 'Treatment of other clinical features'.) •Fixed drug eruption – Management of a fixed drug eruption consists of discontinuation of the causative agent in conjunction with mild- to moderate-strength topical steroid cream and oral antihistamines as needed. (See "Fixed drug eruption", section on 'Management'.)

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