Balanitis xerotica obliterans - Anogenital in
BXO carries a high degree of morbidity, with complications including genital scarring and impaired urinary and sexual function. Recurrent balanitis and acquired phimosis are commonly associated with BXO and are often the presenting complaints. Perianal involvement of BXO is not typically observed. Patients may report itching and burning, but in the early stages, BXO can be asymptomatic. Painful erections, narrowing of the urinary stream, and diminished force during urination may also occur (the latter 2 symptoms may be secondary to urethral stricture formation).
BXO is less commonly associated with genital squamous cell carcinoma (SCC) than the lesions of vulvar lichen sclerosus. However, it is noted that 25% of penile SCC is associated with lichen sclerosus. Penile melanoma in the setting of lichen sclerosus is rare but has been observed, with penile melanoma accounting for less than 1% of penile cancers.
N48.0 – Leukoplakia of penis
198033005 – Balanitis xerotica obliterans
Differential Diagnosis & Pitfalls
- Postinflammatory hypopigmentation seen following repeated episodes of genital herpes or contact dermatitis, or due to a surgical scar.
- Sexual abuse (adult, child) – May be misdiagnosed given areas of purpura with hemorrhage and erosions. It is important to do a thorough clinical history and physical examination with histological confirmation, if necessary.
- Lichen planus
- Lichen simplex chronicus
- Erythroplasia of Queyrat
- Nonspecific balanitis
- Bowen disease
- Gonorrheal balanitis (see gonorrhea)
- Melanoma (penile melanosis mimicking melanoma has been reported in BXO, requiring histologic diagnosis)