Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Management of balanitis in adolescents during puberty involves advising on good daily hygiene, including washing the genital area daily with lukewarm water and keeping the foreskin retracted until the glans penis is dry, where possible.
Avoidance of irritants such as soap, bubble bath, or baby wipes is recommended, and the use of an emollient as a soap substitute can be considered.
Management depends on the likely underlying cause:
- Non-specific dermatitis: prescribe topical hydrocortisone 1% cream or ointment once daily for up to 14 days until symptoms settle, and consider an imidazole cream for up to 14 days.
- Irritant or allergic contact dermatitis: avoid suspected triggers, prescribe topical hydrocortisone 1% cream or ointment once daily for up to 14 days, and advise regular use of an emollient.
- Candidal balanitis: prescribe an imidazole cream until symptoms settle or for up to 14 days; if inflammation causes discomfort, consider adding topical hydrocortisone 1% cream or ointment for up to 14 days.
- Bacterial balanitis: for mild infection, consider topical mupirocin 2% ointment 2–3 times daily for 7–10 days; for severe infection, consider oral phenoxymethylpenicillin for 10 days or oral clarithromycin for 7 days if penicillin-allergic; topical hydrocortisone 1% cream or ointment may be added if inflammation causes discomfort.
Arrange review if symptoms are severe or do not improve after initial treatment, and consider taking a sub-preputial swab to exclude fungal or bacterial infection.
Consider blood tests for HbA1c or HIV if balanitis is severe, persistent, or recurrent, especially if candidal infection is present.