Pseudoepitheliomatous, keratotic and micaceous balanitis of Lortat-Jacob and Civatte

Abstract

History. A 64-year-oId patient was referred to us with persistent abnormalities ofthe glans penis. In 1974 he had been circumcised for a longstanding phimosis with local fusion ofthe prepuce. After this operation, painful, itchy crusts and small fissures were reported to have developed on the glans penis. At the same time the external urethral orifice became stenosed necessitating dilatation. Different local treatments produced no improvement.Examination. Thick white-yellow adherent crusts and scales were seen on the glans penis. The skin had a dry, cracked appearance and some erythematous erosions were present. The general impression was that of an 'armour' surrounding the glans penis.Histology, (glans penis) The epidermis showed extensive areas of local hyperkeratosis and parakeratosis. The keratinocytes showed large hyperchromatic and polymorphic nuclei with mitoses. The dermis contained an infiltrate of lymphocytes, plasma cells and histiocytes.Therapy. Patient is currently being treated with 5-fiuorouracil cream.Comment. Pseudoepitheliomatous, keratotic and micaceous balanitis was first described by Lortat-Jacob and Civatte in I96i.''^ This skin affection occurs in males who have developed phimosis at a later age. After circumcision the typical clinical features develop. Histopathological FIGURE 1. l^seudoepkheiinmatous, keratotic and micaceous balanitis of Lortat-Jacob and Civatte.