This protocol addresses balanoposthitis when the underlying cause is psoriasis of the glans penis and prepuce. The psoriatic skin disease shapes the clinical picture and drives the management approach.
In the circumcised male, penile psoriasis on the glans presents similarly to psoriasis at other body sites — red, scaly plaques. In the uncircumcised male, scaling is typically lost under the foreskin and affected areas appear red and glazed rather than scaly.
Management centres on topical anti-inflammatory therapy. Several evidence-based options are available, and the choice between them is guided by individual clinical factors.
Resolution of genital psoriatic lesions.
DOI: 10.1111/jdv.18954
Psoriasis on the glans in the circumcised male is similar to the appearance of the condition elsewhere, with red scaly plaques.
Scaling is lost on the uncircumcised penis and the patches appear red and glazed.
Moderate potency topical steroids once or twice daily until resolved (with or without antibiotic and antifungal) (1,C)
Topical Vitamin D preparations (calcipotriol or calcitriol applied twice daily). (2,C)
Intermittent topical use of moderate to potent steroids with or without calcipotriol. Potent steroids may not be indicated due to the risk of skin atrophy and bacterial superinfection. (2,C)
Topical calcineurin inhibitors have been used in small studies but should not be used as first line therapy (2,D), and with caution in the uncircumcised.
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