Zoon's balanitis in the pediatric age: Lessons from an unexpected diagnosis

Zoon's balanitis circumscripta plasmacellularis (ZB) is a chronic, benign, and idiopathic inflammatory mucositis that affects uncircumcised males, especially those of middle or advanced age. Its appearance in the pediatric population is exceptional and may go unnoticed.

We present the case of a 14-year-old male with no relevant medical history and a normal physical examination, except for phimosis without dermatitis or other skin lesions, who underwent elective circumcision. The histopathological study of the foreskin revealed epidermal atrophy, a dense band-like inflammatory infiltrate composed predominantly of plasma cells, extravasation of red blood cells, and marked vascular dilation, with no signs of epithelial dysplasia.

ZB should be included in the differential diagnosis of chronic or refractory balanopreputial lesions in adolescents, characterized by erythematous, shiny plaques with multiple punctate spots affecting the glans, foreskin, or both. Since its clinical expression is often nonspecific, the diagnosis is frequently established incidentally by histopathological analysis. Circumcision is not only the most effective treatment, with a low recurrence rate, but also a diagnostic tool that allows confirmation of the benign nature of the process and avoids prolonged and ineffective topical treatments.