Balanitis (Children)
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.
