Candida balanitis

Soorbalanitis, Balanitis candidamycetica, Balanoposthitis candidamycetica.

Fungal infection of the glans penis and foreskin caused by Candida spp. 

• Pathogen: Candida spp. (mostly Candida albicans, C. glabrata also occurs)
• An infection with Candida occurs, for example, during sexual intercourse - especially women often have Candida colonisation in the vagina
• Predisposing factors
  • Topical therapy with external steroids or antibiotic ointments.
  • Hygiene (missing or exaggerated)
  • Phimosis
  • Lichen sclerosus et atrophicans
  • Diabetes mellitus
  • Immunosuppression

• Initial itching
• Erythematous, pruritic, slightly scaly, weeping maculae
• The erythema then becomes flat and shiny, rich reddish-damp
• Blisters and erosions can also occur
• Similar to thrush stomatitis, there may be white spots which form irregular whitish deposits after some time
• With otherwise adequate hygiene, however, a minimal variant is more likely to be seen, i.e. only redness, but the whitish fungal material is washed or cleaned away

• Medical history (predisposing factors)
• Clinical features
• Myco. smear.
• Stool test for Candida.

• Glans penis
• Foreskin
• Shank left out

In the course of the disease inflammatory swelling of the inner preputial sheet can occur up to the inflammatory phimos and increased purulent secretion due to secondary bacterial infection.

Good hygiene.

Frequent relapses.

General measures: 

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

Swivel baths

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

Topical therapy

• Can only be treated well with local therapy.
• For severe inflammation combines steroids and antimycotic
• Antimycotic therapy with
• Clotrimazole cream 1% (Attention: Hexamidine can be irritating)
• Econazole Cream Cream 1%
• Ciclopirox cream Cream or Lsg.
• Ketoconazole cream cream 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.