Makindo Medical Notes

Related Subjects: |Hypospadias |Phimosis |Paraphimosis |Balanitis (Children)

👶 Balanitis (Children) = inflammation of the glans (head of penis). It may also involve the foreskin (balanoposthitis). Usually mild, but can cause pain, distress, and hygiene difficulties.

📖 About

• Common in boys with a non-retractile foreskin.
• Not usually serious, but recurrent cases may indicate underlying issues.

🧪 Aetiology

• Often linked to poor hygiene or irritation under a tight foreskin.
• Can be due to infection (candida, bacteria) or dermatitis-type inflammation.

⚡ Clinical Features

• Redness, soreness, and swelling of the glans ± foreskin.
• Itching, irritation, or burning.
• Possible discharge under the foreskin.
• Pain when passing urine (dysuria).

🔍 Investigations

• Urinary glucose dipstick 🧪 — to exclude diabetes mellitus if recurrent or severe.
• Sub-preputial swab if no improvement after 7 days or atypical features.

💊 Management (NICE Guidance)

• 🧼 General care:
  • Clean gently with lukewarm water; pat dry.
  • Do not forcibly retract foreskin if non-retractile.
  • Avoid soap, bubble bath, baby wipes.
  • Frequent nappy changes if applicable.
• 🌿 Non-specific dermatitis (± candida/bacteria): Topical hydrocortisone 1% OD + topical imidazole (e.g. clotrimazole 1%, miconazole 2%). Continue until settled (≤14 days).
• ⏳ If no improvement in 7 days: Stop hydrocortisone, take a swab, and treat according to results.
• 🍄 Suspected candidal balanitis: Topical imidazole cream (clotrimazole, econazole, ketoconazole, or miconazole). If inflamed, add hydrocortisone 1% for ≤14 days.
• 🦠 Suspected bacterial balanitis: Oral flucloxacillin 7 days (first line). If penicillin allergy → erythromycin or clarithromycin 7 days. Add topical hydrocortisone if inflammation causes discomfort.

🌟 Teaching Pearl

• Recurrent balanitis in boys with a tight foreskin → consider pathological phimosis (e.g. lichen sclerosus/BXO) → urology referral.
• Balanitis + ballooning of foreskin on urination → may suggest obstruction.