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Zoon balanitis: not a distinct clinicopathological entity?

Richard E Watchorn^1,2, Claire Doyle¹, Georgios Kravvas²

¹Department of Dermatology, Beaumont Hospital, Beaumont Road, Dublin, Ireland.

Clinical and Experimental Dermatology

|November 1, 2024

Summary

Zoon balanitis (ZB) may not be a distinct condition but often presents as a manifestation of male genital lichen sclerosus (MGLSc). This review suggests discontinuing ZB as a separate clinicopathological entity.

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Area of Science:

Urology
Dermatology
Pathology

Background:

Zoon balanitis (ZB) was initially described as a distinct clinicopathological entity.
Its status as a separate diagnosis has been debated, with suggestions it may be related to male genital lichen sclerosus (MGLSc).

Purpose of the Study:

To review historical literature on Zoon balanitis (ZB).
To determine if clinical or histological features of male genital lichen sclerosus (MGLSc) were present but overlooked in reported ZB cases.

Main Methods:

A comprehensive review of 101 published papers on Zoon balanitis (ZB).
Analysis of images from 66 papers to identify clinical signs of male genital lichen sclerosus (MGLSc).

Main Results:

98.5% of analyzed ZB images displayed clinical signs consistent with male genital lichen sclerosus (MGLSc).
Observed signs included adhesions, effacement of the coronal sulcus and frenulum, and glans etiolation.

Conclusions:

Zoon balanitis (ZB) appears to be a manifestation of male genital lichen sclerosus (MGLSc) in most cases.
The recognition of Zoon balanitis (ZB) as a distinct clinicopathological entity should be reconsidered.