tacrolimus and Balanitis

Plasma cell balanitis of Zoon (PCBZ) and plasma cell vulvitis (PCV) are characterized as idiopathic, benign, chronic irritant mucositis. The clinical symptoms and signs usually persist or reappear after treatment withdrawal. Therefore, many therapies have been tried and are available. Recently, several reports of PCBZ and PCV treated with calcineurin inhibitors, tacrolimus and pimecrolimus, have been reported in the literature. We present 9 cases of PCBZ treated with tacrolimus 0.1% ointment (Protopic, Toyama, Japan) that showed good therapeutic results within 4 weeks of treatment, and we review the literature of PCBZ and PCV and their response to these topical immunomodulators. Based on the current literature and on the anecdotal experience, we believe that topical calcineurin inhibitors may serve as a therapeutic option in recalcitrant plasma cell balanitis and vulvitis.

Topics: Administration, Cutaneous; Adult; Aged; Aged, 80 and over; Balanitis; Calcineurin Inhibitors; Humans; Immunosuppressive Agents; Male; Middle Aged; Plasma Cells; Severity of Illness Index; Tacrolimus

Inflammatory mucosal disorders are treated conventionally with potent or superpotent topical corticosteroids. For more than 20 years, topical cyclosporine has been used in the management of oral mucous membrane affections. Recently other topically applied calcineurin inhibitors, namely tacrolimus and pimecrolimus, expanded the armamentarium for the treatment of inflammatory mucosal diseases. This chapter places its main emphasis on the efficacy and safety of topical calcineurin inhibitors in the management of different oral and genital conditions, including anogenital lichen sclerosus (LS), oral and genital lichen planus, plasma cell balanitis and vulvitis, mucous membrane pemphigoid and pemphigus vulgaris, all conditions having usually a protracted course, requiring long-lasting treatment. There is current evidence for the effectiveness of both pimecrolimus and tacrolimus in the topical treatment of inflammatory oral mucosal diseases and genital dermatoses, especially oral lichen planus and genital LS.

Topics: Administration, Topical; Adrenal Cortex Hormones; Anti-Inflammatory Agents; Balanitis; Calcineurin Inhibitors; Carcinogens; Female; Genital Diseases, Female; Humans; Lichen Planus; Lichen Planus, Oral; Lichen Sclerosus et Atrophicus; Male; Mucositis; Paraneoplastic Syndromes; Pemphigoid, Benign Mucous Membrane; Pemphigus; Tacrolimus; Vulvitis

Non-specific balanitis is a common inflammatory dermatosis with frequent relapses and considerable impact on male sexual life.. To evaluate the efficacy and safety of pimecrolimus 1% cream in recurrent non-specific balanitis.. Twenty-six patients with recurrent flares of non-specific balanitis were randomly assigned to 1 group applying pimecrolimus cream 1% and 1 group applying placebo on the glans twice daily for 7 days. The patients were assessed on day 14. They were instructed to continue applying the agent whenever symptoms initialized for the following 90 days and take account of the cumulative days with symptoms.. Seven out of the 11 (63.6%) patients in the pimecrolimus group and 1 out of 11 (9%) in the control group were free of all symptoms and lesions after 14 days, 3 (27.3%) in both groups reported improvement, while 1 (9.1%) in the pimecrolimus and 7 (63.6%) in the control group remained unaffected. (chi(2) = 9.0, d.f. = 2, p = 0.011). Days with symptoms during the 90-day follow-up period were 7.50 +/- 3.02 for the pimecrolimus and 17.62 +/- 4.40 for the control group (p = 0.000064).. Pimecrolimus 1% cream is promising in relieving symptoms and signs of non-specific balanitis during flares and controlling the disease during long-term follow-up.

Topics: Administration, Topical; Adult; Anti-Inflammatory Agents, Non-Steroidal; Balanitis; Dermatologic Agents; Double-Blind Method; Emollients; Humans; Male; Middle Aged; Recurrence; Tacrolimus; Treatment Outcome

Topics: Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Balanitis; Betamethasone; Biopsy; Dermoscopy; Fusidic Acid; Glucocorticoids; Humans; Infant; Male; Plasma Cells; Tacrolimus

Circinate balanitis is the commonest cutaneous manifestation of reactive arthritis (Reiter syndrome), but can also occur independently. Topical corticosteroid therapy is the most commonly used treatment, and topical calcineurin inhibitors have also been used successfully. We report a case of a 20-year-old man who presented with discrete erythematous patches with slightly raised keratotic annular borders on his glans penis. He also developed geographic tongue and severe arthritis. A clinical diagnosis of circinate balanitis was made, which was supported by the psoriasiform features on skin biopsy. The patient failed to respond to topical 0.05% clobetasol propionate cream, but a novel approach using a combination of dapsone and topical 0.1% tacrolimus ointment successfully cleared his rash.

Topics: Balanitis; Dapsone; Drug Therapy, Combination; Humans; Immunosuppressive Agents; Male; Tacrolimus; Treatment Outcome; Young Adult

Plasma cell balanitis of Zoon is a chronic, benign, inflammatory dermatosis of the glans penis and prepuce. The exact aetiology is unknown. The treatments described to date have provided only partially successful results. Recently, several reports of plasma cell balanitis successfully treated with calcineurin inhibitors have been published. We report 3 cases of plasma cell balanitis refractory to several treatments with steroids and antifungals treated with pimecrolimus 1% cream applied twice daily: 1 patient had a complete resolution, 1 patient had a marked response but relapsed during the treatment and the last patient had a partial response due to the development of a side effect that precociously required to stop the treatment. One patient referred a slight pruritus after the first applications of the cream that spontaneously disappeared after a few minutes. Additional experiences are needed to determine if topical pimecrolimus is an effective and safe treatment for plasma cell balanitis.

Topics: Administration, Cutaneous; Aged; Aged, 80 and over; Anti-Inflammatory Agents, Non-Steroidal; Balanitis; Dermatologic Agents; Emollients; Humans; Immunosuppressive Agents; Male; Plasma Cells; Reproducibility of Results; Tacrolimus; Treatment Outcome

Reactive arthritis is the current name for the clinical triad characterized by arthritis, urethritis, and conjunctivitis, which develops over the course of a month or more. In some patients, this clinical triad is accompanied by circinate balanitis and keratoderma on the palms and soles. Balanitis, in some cases, is refractory to conventional therapy and can be recurrent, becoming a therapeutic challenge.. A total of 4 clinical cases of male patients, with ages ranging from 21 to 36 years old, presented with arthritis, conjunctivitis, urethritis, and recurrent circinate balanitis, which developed over a period of 1 to 6 months. All patients were treated with corticosteroids and sulfasalazine. In addition, one was treated with ciprofloxacin; however, balanitis was resistant to treatment in 3 patients.. As other treatments had failed, topical 0.1% tacrolimus was used, with excellent results, as the balanitis lesions were cleared during the first week of topical therapy.. We propose the complementary use of topical tacrolimus in cases of reactive arthritis associated with circinate balanitis.

Topics: Administration, Topical; Adult; Arthritis, Reactive; Balanitis; Humans; Immunosuppressive Agents; Male; Tacrolimus; Young Adult

Topics: Administration, Topical; Balanitis; Diagnosis, Differential; Foreskin; Humans; Immunosuppressive Agents; Male; Middle Aged; Tacrolimus

Plasma cell balanitis is a disorder of the middle-aged and older uncircumcised male. Several treatments have been proposed to treat this disease, but plasma cell balanitis is often resistant to conventional therapy.. We decided to evaluate the efficacy and tolerability of pimecrolimus 1% cream in resistant Zoon's balanitis. We report two cases of resistant Zoon's balanitis treated with topical pimecrolimus 1% cream.. One of the two patients had a complete regression of the lesion after 2 months of therapy. The other one had a great improvement of the lesion, but a hyperpigmented patch persisted on the glans.. Pimecrolimus 1% cream may be a valuable second-line treatment for patients with steroid related side effects or with steroid and other conventional therapy resistant Zoon's balanitis, as well as for those rejecting circumcision.

Topics: Administration, Topical; Aged; Balanitis; Dermatologic Agents; Humans; Male; Tacrolimus

Erythroplasia of Queyrat of the glans penis developed in a 79-year-old uncircumcised man on a background of biopsy proven Zoon's plasma cell balanitis affecting the same site on the glans. The Zoon's plasma cell balanitis had been treated with topical pimecrolimus for 1 month prior to the development of clinically evident erythroplasia of Queyrat. He was subsequently treated with topical 5-fluorouracil 5% for 2 weeks, which resulted in clinical clearance. He has since been circumcised.

Topics: Aged; Balanitis; Carcinoma in Situ; Carcinoma, Squamous Cell; Circumcision, Male; Erythroplasia; Humans; Immunosuppressive Agents; Male; Penile Neoplasms; Penis; Plasma Cells; Tacrolimus

Topics: Administration, Topical; Aged; Aged, 80 and over; Balanitis; Humans; Immunosuppressive Agents; Male; Tacrolimus

Balanitis xerotica obliterans (BXO) is a chronic and progressive dermatitis of unknown aetiology and incidence. Its management in childhood is controversial. Although in most cases only the prepuce is affected, meatal and urethral involvement may lead to major surgical reconstruction. Therefore complete surgical excision of the affected skin is considered to be mandatory. In case of involvement, incidental histological evidence or a relapse, or when complete removal of the affected skin is not possible, a topical therapy should be implemented. In a retrospective analysis of our study population (13 children) with BXO, relapse rate was lower after topical therapy with tacrolimus (Protopic), a highly selective immune modulator, than after the standard anti-inflammatory therapy with betamethasone. The use of tacrolimus ointment is a safe therapy with no severe side effects. Due to the fact that there are no predictive factors for progression or relapse of BXO, we consider a topical anti-inflammatory therapy is always indicated after any type of surgery for BXO. Follow-up monitoring should be close, so that any relapse can be detected and treated as early as possible.

Topics: Administration, Topical; Adolescent; Balanitis; Betamethasone; Child; Child, Preschool; Circumcision, Male; Combined Modality Therapy; Follow-Up Studies; Humans; Male; Penis; Recurrence; Tacrolimus; Urethral Stricture

Topics: Administration, Topical; Balanitis; Humans; Immunosuppressive Agents; Male; Middle Aged; Plasma Cells; Remission Induction; Tacrolimus

Topics: Balanitis; Carcinoma, Squamous Cell; Humans; Immunosuppressive Agents; Male; Middle Aged; Penile Neoplasms; Tacrolimus

Topics: Balanitis; Humans; Immunosuppressive Agents; Male; Middle Aged; Plasma Cells; Tacrolimus

Topics: Administration, Cutaneous; Balanitis; Dermatologic Agents; HLA-B27 Antigen; Humans; Male; Middle Aged; Tacrolimus; Treatment Outcome

Topics: Administration, Cutaneous; Balanitis; Humans; Immunologic Factors; Male; Tacrolimus

Plasma cell balanitis or balanitis of Zoon (BZ) is a frequent diagnosis in mature men and lesions are generally localized on the glans but may involve the prepuce; its aetiology remains unknown.. To present our experience with tacrolimus 0.1% ointment in the treatment of two patients with BZ refractive to other topical treatments.. Two uncircumcised mature caucasian males were seen, both presenting with BZ; topical tacrolimus 0.1% ointment twice daily was prescribed in each case.. Marked improvement of the lesions in both patients has been observed, with follow-up of 1 year and 10 months, respectively.. Topical tacrolimus 0.1% ointment is an effective and safe treatment for BZ.

Topics: Aged; Balanitis; Follow-Up Studies; Humans; Immunosuppressive Agents; Male; Ointments; Plasma Cells; Tacrolimus

Topics: Aged; Balanitis; Humans; Immunosuppressive Agents; Male; Middle Aged; Tacrolimus; Treatment Outcome

Topics: Adult; Balanitis; Circumcision, Male; Humans; Immunosuppressive Agents; Male; Tacrolimus