ABSTRACT

The circumscribed, nonpainful lesions shown here developed without any intercurrent illness in a 60-year-old man. Biopsy reveals a plasma cell infiltrate. What is the lesion?

a. Circinate balanitis of Reiter’s syndrome b. Erythroplasia of Queyrat c. Syphilis d. Lichen planus e. Zoon’s balanitis

• Zoon’s balanitis also is known as balanitis circumscripta plasmacellularis and plasma cell balanitis

• It was first described by J.J. Zoon in 1952. In 1954, Zoon also described the vulvar equivalent in women

• Clinically, it usually presents with a yellow or blood-tinged sterile discharge and painless, glistening, maculopapular lesions. Multiple pinpoint, bright-red “cayenne pepper” spots often are noted

• Histologic results include a bandlike (lichenoid) inflammatory infiltrate with plasma cell predominance and hemosiderin deposition in the subcutaneous tissues. Keratinocytes are thinned and “lozenge-shaped” with “watery spongiosis” or edematous widening of the intercellular spaces

• The condition is benign. No treatment is necessary, but topical corticosteroids have been used

• Classically described in elderly uncircumcised men, circumcision has been reported to result in resolution of the lesions

• Differential diagnosis for papulosquamous penile lesions includes psoriasis, lichen planus, lichen sclerosis, cicatricial pemphigoid, secondary syphilis, drug reactions, erythroplasia of Queyrat, bowenoid papulosis, and circinate balanitis of Reiter’s syndrome