A retrospective study of 129 patients with plasma cell balanitis

Abstract

Background: Plasma cell balanitis (PCB) is a chronic inflammatory dermatosis of the glans penis and prepuce, typically presenting as discrete shiny bright red plaques. Research on PCB is scarce, with case reports and small series. The aetiology, incidence and prevalence of PCB remain unclear. Circumcision is considered as the treatment of choice. Topical treatments such as topical corticosteroids, calcineurin inhibitors, fucidic acid and imiquimod have been widely used, but they lack evidence of efficacy. Objectives: The objective of this study was to investigate the clinical profiles, treatment methods and outcomes of PCB patients in a relatively large cohort. Methods: We concluded a retrospective study of 129 patients with the diagnosis of PCB between 1 January 2003 and 31 December 2018 at Tampere University Hospital (TAYS) dermatology department. Results: The majority of patients were treated with topical treatments only, while 31 patients (24%) eventually underwent circumcision. The most used and most effective topical treatments were tacrolimus (0.03% or 0.1%) and clobetasol propionate. Those treated with circumcision had a shorter follow-up time (median 8 months vs. 47 months, p = 0.002) and were more likely to reach remission (46% vs. 16%, p = 0.002) compared with those treated with only topical treatments. Patients with more severe symptoms were more often treated with several topical treatments and to undergo circumcision, and they were more likely to ultimately reach remission. The follow-up time was longer among patients with a histopathologic diagnosis than with a clinical diagnosis (median 16 months vs. 6 months, p = 0.01). Conclusions: Topical treatments are rarely curative, but among them tacrolimus and topical corticosteroids show the strongest evidence of efficacy. The rate of remission is significantly better among those circumcised, and it is to be considered already at an early stage. Further studies are needed to find the best care management for PCB.