Balanitis circinata (also known as circinate balanitis) is a skin condition of

reactive arthritis Reactive arthritis, also known as Reiter's syndrome, is a form of inflammatory arthritis that develops in response to an infection in another part of the body (cross-reactivity). Coming into contact with bacteria and developing an infection can t ...

comprising a serpiginous ring-shaped

dermatitis Dermatitis is inflammation of the skin, typically characterized by itchiness, redness and a rash. In cases of short duration, there may be small blisters, while in long-term cases the skin may become thickened. The area of skin involved c ...

of the

glans penis In male human anatomy, the glans penis, commonly referred to as the glans, is the bulbous structure at the distal end of the human penis that is the human male's most sensitive erogenous zone and their primary anatomical source of sexual pl ...

. Circinate balanitis is one of the most common cutaneous manifestation of reactive arthritis. However, balanitis circinata can also occur independently. Topical corticosteroid therapy is the most commonly used treatment, and topical calcineurin inhibitors have also been used successfully.

Signs and symptoms

At the beginning, people show pin-sized dots with white plaque on them which constantly grow into flat, red areas hardly surrounded by white plaque. Despite the visible symptoms, patients in nearly all cases do not suffer from burning or itching, nor does it smell strange. Due to its analogy to a fungal skin infection, balanitis circinata is often misdiagnosed as mycosis – especially in cases where patients have no other symptoms of

Cause

Reactive arthritis Reactive arthritis, also known as Reiter's syndrome, is a form of inflammatory arthritis that develops in response to an infection in another part of the body (cross-reactivity). Coming into contact with bacteria and developing an infection can t ...

is characterized by nongonococcal urethritis,

conjunctivitis Conjunctivitis, also known as pink eye, is inflammation of the outermost layer of the white part of the eye and the inner surface of the eyelid. It makes the eye appear pink or reddish. Pain, burning, scratchiness, or itchiness may occur. Th ...

, and

arthritis Arthritis is a term often used to mean any disorder that affects joints. Symptoms generally include joint pain and stiffness. Other symptoms may include redness, warmth, swelling, and decreased range of motion of the affected joints. In som ...

. Reactive arthritis belongs to the group of arthritides known as the spondyloarthritides. There are two main types of reactive arthritis: post-venereal and post-enteric. '' Chlamydia trachomatis'' is thought to be the most common cause of reactive arthritis, in general. Until recently, even the terminology for the condition itself was unclear as multiple eponyms and names have been associated with reactive arthritis. In recent years, a great deal has been learnt about the epidemiology, pathophysiology and treatment of reactive arthritis and chlamydia-induced reactive arthritis, specifically. Prospective epidemiologic data suggest that chlamydia-induced reactive arthritis is underdiagnosed. Other truths being actively revealed include data suggesting that the pathogen itself (i.e., chlamydia) might play an equally important role, or perhaps even more important, than the host with disease susceptibility; asymptomatic chlamydial infections might be a common cause of reactive arthritis and the two variants of reactive arthritis might respond differently to treatment in spite of the congruent clinical presentation. However, much about this syndrome remains shrouded in mystery. Recent data has been suggesting that Chlamydia-induced reactive arthritis might be a common condition that clinicians are simply failing to recognise. Therefore, an emphasis is placed on disease awareness since viable treatment options are emerging.

Treatment

Balanitis circinata is one out of multiple manifestations of the reactive arthritis. Right now, topical corticosteroid therapy is the most commonly used treatment, and topical calcineurin inhibitors have also been used successfully. Newer tests on patients showed that a less harmful

off-label Off-label use is the use of pharmaceutical drugs for an unapproved indication or in an unapproved age group, dosage, or route of administration. Both prescription drugs and over-the-counter drugs (OTCs) can be used in off-label ways, although ...

topical treatment with the

immunomodulator Immunotherapy or biological therapy is the treatment of disease by activating or suppressing the immune system. Immunotherapies designed to elicit or amplify an immune response are classified as ''activation immunotherapies,'' while immunotherap ...

pimecrolimus or the

immunosuppressant Immunosuppressive drugs, also known as immunosuppressive agents, immunosuppressants and antirejection medications, are drugs that inhibit or prevent activity of the immune system. Classification Immunosuppressive drugs can be classified in ...

tacrolimus can prevent all visible symptoms of this disease. Since reactive arthritis cannot be healed as such, affected people are forced to a continuous topical treatment – otherwise they will again note first symptoms after three to four days without it. However, strong debates and controversies continue regarding the exact indications of immunomodulators like pimecrolimus and their duration of use in the absence of active controlled trials. A study released in 2015 (tested were 7,457 children with a total of 26,792 person-years) did not find any evidence that pimecrolimus could cause cancer.

References

{{reflist Inflammations Urological conditions Cutaneous conditions Chlamydia infections