Introduction Demographics Causes Clinical features Complications Diagnosis Differential diagnoses Treatment Prevention Outcome
Pseudoepitheliomatous keratotic and micaceous balanitis (PKMB) is a rare skin condition that affects the penis. It is characterised by the presence of multiple small, scaly, and micaceous papules that gradually take on a silvery-white appearance.
PKMB is typically seen in older uncircumcised men, or those with predisposing risk factors (see causes).
The cause of pseudoepitheliomatous keratotic and micaceous balanitis is not fully understood, but may be associated with chronic inflammation of the penile skin.
Contributory risk factors include autoimmune conditions, sexually transmitted infections, and poor hygiene. Individuals with a history of lichen sclerosus, genital warts, or human papillomavirus (HPV) infections may also be at increased risk.
PKMB appears as micaceous papules on the penis which may vary in colour from brown to grey and white, and can also appear silvery due to mica-like crusts and keratotic horny masses.
Symptoms include an itching, burning, and painful sensation in the affected area as well as difficulty retracting the foreskin. Involvement around the perimeatal skin can cause difficulties with micturition.
Complications of PKMB can be due to chronic inflammation or ulceration. This includes:
Skin biopsies of the affected area will help clarify the diagnosis of PKMB, as clinical appearances may mimic other conditions.
Histological findings typically show:
Histopathology may also show inflammation within the affected area, with infiltration of immune cells such as lymphocytes and plasma cells. For more information, see Pseudoepitheliomatous keratotic and micaceous balanitis pathology.
Additional investigations may help exclude other causes of the lesion including periodic acid-Schiff (PAS) stain for fungal infection, and genital swabs or serological testing for sexually transmitted infections.
Treatment of PKMB can vary depending on the severity and extent of the condition.
PKMB may be prevented by reducing irritation, inflammation, and infection of the genital area, by:
The outcome of PKMB can vary depending on the severity and extent of the condition. Some consider the condition premalignant, as malignant transformation to invasive disease has been reported.
Four stages of progression have been theorised by Krunic et al:
Early diagnosis and treatment are essential for symptom control and reducing the risk of complications. The clinical course is chronic, and recurrences may occur following treatment.
