General
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• Infection of glans and foreskin, usually due to Candida, Staph, Strep, Garderella, anaerobes or pyogenic bacteria (Acta Derm Venereol 2008;88:331, eMedicine)

Epidemiology
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• Common in uncircumcised newborns or uncircumcised men with poor hygiene and accumulation of smegma
• May be due to poor hygiene, sexual transmission or associated with dermatologic disorders

Etiology
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• Due to propensity of pathogenic bacteria to adhere to inner mucosal surface of foreskin
• Often sexually transmitted in adults (Hinyokika Kiyo 2005;51:737)
• Also sexually transmitted for adults with Candida albicans, with pathogenicity concentrated to a few genotypes (Clin Infect Dis 2008;47:1119)

Clinical features
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• Causes phimosis
• Malassezia is commonly identified, but at same rate as in controls (Acta Derm Venereol 2008;88:331)

Case reports
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• Boys with neutropenia and Pseudomonas aeruginosa infection (Int J Infect Dis 2010;14:e344)
• 58 year old man with granulomatous papules after intravesical bcg for bladder cancer (Int J Urol 2006;13:1361)

Treatment
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• Antibiotics, based on empiric anti-fungal therapy (Candida is most common cause), or culture (Int J Dermatol 2009;48:121)

Clinical images
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Marked ulceration with tissue destruction

Red eroded rash

Micro description
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• Non-specific inflammatory infiltrate with lymphocytes, plasma cells and macrophages
• Causative agent usually not discernable by routine examination
• Epithelial changes such as squamous hyperplasia and ulceration can be associated with inflammation
• Fungal hyphae may be present

Micro images
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Dermis with lymphoplasmacytic
infiltrate and dilated blood vessels

Positive stains
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• PAS/GMS for fungi

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