Candida balanitis

Soorbalanitis, balanitis candidamycetica, balanoposthitis candidamycetica.

Fungal infection of the glans penis, as well as the foreskin, triggered by Candida spp.

• Pathogen: Candida spp. (mostly Candida albicans, C. glabrata also occurs).
• Infection with Candida occurs, for example, during sexual intercourse - women in particular often have Candida colonisation in the vagina.
• Predisposition factors
  • Topical therapy with external steroids or antibiotic ointments.
  • Hygiene (lack of or excessive)
  • Phimosis
  • Lichen sclerosus et atrophicans
  • Diabetes mellitus
  • Immune suppression

• Initial pruritus.
• Erythematous, pruritic, slightly scaly, weeping macules.
• The erythema then becomes two-dimensional and rich red-moist shiny.
• Vesicles and erosions may also occur.
• Similar to thrush stomatitis, there may be the white stipples that form irregular whitish deposits after a period of time.
• However, with otherwise adequate hygiene, one tends to see a minimal variant, i.e. only redness, but the whitish fungal materials are washed or -cleaned away in each case.

• Anamnesis (predisposition factors).
• Clinical.
• Myco.smear.
• Stool examination for Candida.

• Glans penis
• Foreskin
• Shaft left out

During the course of the disease, there may be inflammatory swelling of the inner prepuce leaf to the point of inflammatory phimos and stronger purulent secretion as a result of secondary bacterial infection.

Good hygiene.

Frequent recurrences.

General measures:

• Partner treatment (also for asymptomatic partners)!
• If there is a predisposing underlying disease, it should be addressed therapeutically!
• Adequate hygiene!
• Underpants and towels should be changed daily and washed with maximum heat
• Apply olive oil for cleaning, do not use soaps.
• Question about previous (possibly inadequate) antibiotic therapy with reduction of physiological flora

Swim baths

• Disinfectant panning baths, e.g. polyvidone iodine (dilute in warm water until it looks like a "bad coffee", pan for 10min).
• Baths with mild tanning agents are also useful.

Topical therapy

• Well treatable with local therapy only
• For severe inflammation, combined steroids and antifungal
• Antifungal therapy with
  • Clotrimazole cream 1% (Caution: Hexamidine may irritate)
  • Econazole cream 1%
  • Ciclopirox cream cream or solution
  • Ketoconazole Cream Crème 2%
  • Amorolfin cream 0.25% cream

Systemic therapy

• For severe infestation: Fluconazole 150mg 1xtgl. p. o.

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7. Braun-Falco`s Dermatologie Venerologie und Allergologie, 6. Auflage
8. Edwards et. al. 2013 European guideline for the management of balanoposthitis. Int J STD AIDS. 2014 Aug;25(9):615-26.