This protocol covers the management of balanoposthitis occurring in the specific setting of penile intraepithelial neoplasia (PeIN) where the underlying condition is strongly associated with human papillomavirus (HPV) infection and/or lichen sclerosus.
PeIN lesions in this presentation are strongly associated with human papillomavirus infection and/or lichen sclerosus.
The risk is further elevated when concomitant immune-incompetence is present — including untreated HIV infection, organ transplant recipients, and patients receiving small molecule or biologic immunosuppressants.
Management draws on topical medical treatments or, alternatively, surgical and ablative interventions. Adjunctive measures targeting the underlying risk factors are also incorporated into the approach.
DOI: 10.1111/jdv.18954
They are strongly associated with human papillomavirus infection and/or lichen sclerosus.
The risk is increased if there is concomitant immune-incompetence such as in untreated HIV, in organ transplant patients or in those treated with small molecule (e.g. azathioprine, cyclosporin, methotrexate and leflunamide) or biologic immunosuppressants.
Imiquimod 5% (1,C) · Fluorouracil cream 5% (2,C) · Fluorouracil 0.5%/salicylic acid 10% combination (2,C) · Surgical excision (local excision is usually adequate and effective) (1,B) · Mohs' micrographic surgery (1,B) · Cryotherapy (2,D) · Photodynamic therapy (2,D) · Laser (2,D) · Mandatory circumcision for balanopreputial disease, especially for uncircumcised high-risk scenarios (e.g. HIV and transplant recipient) (1,D) · Polyvalent HPV vaccination (2,D) · Smoking cessation (2,D)
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