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Acornitis: itching on the penis

Acornitis: itching on the penis

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Inflammation of the glans penis - balanitis

Inflammation of the glans penis is an extremely unpleasant and annoying symptom due to the associated itching and the pain that may occur. Balanitis can be due to both infectious and non-infectious causes.


The technical term “balanitis” refers to inflammation of the outer layers of the skin on the glans penis of the male genitals or the penis. If the inflammation also spreads to the inside of the foreskin, this is known as “balanoposthitis”.

Symptoms of acorn inflammation

Patients generally complain of “itching on the penis”. Basically, balanitis usually shows up in the form of reddening of the skin and superficial skin damage. The redness is often visible as spots on the glans, but sometimes the entire glans appears red. This can swell significantly in the course of the inflammation. The damage to the skin is accompanied by increased itching and possibly pain or an uncomfortable burning sensation.

The surface of the affected skin areas often appears slightly wet. Depending on the cause of balanitis, there may be various other symptoms. Examples include the formation of dandruff, a varnish-like change in the surface of the skin, punctual bleeding, purulent discharge in men or the development of ulcers.

In the case of balanoposthitis, the skin damage can also be observed in the area of ​​the foreskin. If the glans inflammation is due to an infectious event or another underlying disease, numerous other accompanying symptoms can occur, each of which is explained in more detail in connection with the causes.

Causes of itching on the penis

In the triggers of balanitis, a distinction must first be made between infectious and non-infectious causes. Infectious penile infections can be mycogenic, bacterial, viral and parasitic in nature. The non-infectious glans inflammation arises, for example, from mechanical irritation of the skin, allergic reactions or chronic skin diseases. Then follows a brief overview of the common triggers of balanitis.

Inflammation of the glans from infections

Infectious inflammations are usually characterized by a relatively acute course. They arise from infestation with bacteria (e.g. from the genus of staphylococci and streptococci), viruses (e.g. genital herpes viruses and human papillomaviruses; HPV), fungi (usually yeast or Candida) or parasites (Trichomonas vaginalis).

Inadequate hygiene can significantly increase the risk of bacterial balanitis, since so-called smegma collects under the foreskin, which favors the multiplication of the germs. A weakened immune system, diabetes and narrowing of the foreskin (phimosis) also contribute to an increased risk of balanitis.

On a bacterial level, it is not uncommon for rectal germs to be the trigger. All pathogens of the infectious glans inflammation can theoretically be passed on during sexual intercourse and trigger corresponding illnesses in the fellow human beings. Special care is therefore required here. Infectious inflammation of the glans can also be observed in connection with severe courses of urethritis. A typical feature in this case is usually an accompanying genital discharge. In addition to severe penile itching, pain when urinating and disturbances in urine output can be part of the symptoms.

Non-infectious balanitis

The most common form of non-infectious glans inflammation is so-called balanitis simplex, which is caused by skin irritation. These irritations can arise, for example, from excessive intercourse, but also from excessive genital hygiene. The acorn's very thin skin is attacked or damaged by soap and drying with a towel. With frequent repetition of the procedure, inflammatory skin irritations are the result.

In rare cases, these can be caused by unsuitable underwear or the associated mechanical irritation. Allergic reactions, for example to shower gel, body lotions or condoms, can also cause acorn inflammation, which usually occurs immediately after using the products.

A special form of non-infectious inflammation is the so-called balanitis circinata. This belongs to the complex of symptoms of Reiter's disease, which can occur in predisposed people after a surviving genital or gastrointestinal infection. The symptoms include reactive arthritis, urethritis, balanitis, skin changes and conjunctivitis. Not all symptoms always appear.

Cause skin diseases

Itching on the penis can occur as part of psoriasis if the latter is manifested on the glans penis.

This also applies to the chronic skin disease Lichen sclerosus et atrophicans, which is known in the professional world as a trigger of balanitis xerotica obliterans. This form of acorn inflammation is accompanied by the formation of white, porcelain-like spots and sclerotic skin changes.
As a result of genital lichen sclerosus or the associated atrophy (tissue damage), men often suffer from a narrowing of the foreskin and, if necessary, from gluing of the foreskin and glans.

Another chronic inflammatory skin disease that can be the cause of acorn inflammation is the so-called nodular lichen (lichen planus). If this affects the genital area (which is rarely the case), whitish skin discolouration and painful open areas in the area of ​​the glans may appear.

Chronic glans inflammation

The so-called plasmacellularis balanitis (also known as Zoon's disease) forms a chronic form of glans inflammation, the causes of which are still not fully understood. Irregular reddish spots with a moist, varnish-like glossy surface are typical signs of the disease. There is also an increase in punctiform bleeding on the affected skin areas of the glans. Foreskin narrowing and adhesions can also occur in the context of plasmacellularis balanitis.

Atrophy of the epidermis occurs with loss of the stratum corneum and stratum granulosum. The possible cause of the disease is, for example, the accumulation of moisture under the foreskin (prepuce). Warmth, moisture and accumulated smegma are said to favor the inflammation. Special anaerobic bacteria probably also play a role here, which spread in the warm and humid environment. Slight incontinence is known as a risk factor for plasmacellularis balanitis. Neglected genital hygiene can promote the development of chronic glans inflammation.

The so-called balanitis gangraenosa, which is caused by a disease of Fournier disease (also Fournier gangrene) is extremely rare. The cause of this special form of necrotizing fasciitis (inflammation and atrophy of the subcutaneous tissue and fasciae) is the pathological increase in aerobic and anaerobic bacteria in the corresponding tissue layers. The affected skin areas show a relatively sudden swelling, redness and blistering. In the further course there follows a necrosis (death) of the skin layers and fascia lying below. The disease is often fatal.


The medical history provides essential information on the diagnosis. Those affected are asked about the symptoms, their occurrence and possible connections with personal hygiene and hygiene. Doctors also inquire about known skin diseases and allergies that may be related. Since diabetes is considered a risk factor for balanitis, doctors generally also ask about existing diabetes.

After a thorough medical history, a first visual examination of the skin appearance follows. In this context, it is also checked whether there is a narrowing of the foreskin. The laboratory examination of a urine sample and a skin smear from the area of ​​the glans serves to detect pathogens in infectious balanitis. The urine sample often gives indications of a possible accompanying urethritis.

If the examinations mentioned do not allow a clear diagnosis, taking a tissue sample (biopsy) remains the last option in order to arrive at a reliable diagnosis and to identify possible cancers or precursors of a tumor. If there is a suspicion that the inflammation is the result of a general skin disease, the doctors look for further signs of these diseases in other parts of the body. An accompanying blood test can also provide evidence of reactive arthritis or other systemic diseases that may be present.


At the beginning of treatment, patients should generally be given detailed information about their condition, whereby the risk of transmission should also be discussed in order to avoid the so-called ping-pong effect with mutual infections of the sex partners. Thorough genital hygiene with no skin irritant soap, perfume, shower or intimate detergent is generally recommended for acorn infections. It should be borne in mind that an excessive amount of cleaning can trigger the symptoms.

Treatment of infectious balanitis

If the inflammation of the glans is due to a bacterial infection, an external treatment with antibiotic-containing creams and ointments is carried out for less severe forms. Severe forms of bacterial balanitis are treated with the systemic use of antibiotics.

Anti-fungal therapy, usually applied in the form of creams to the affected areas, is used to treat candida balanitis (inflammation of the glans from yeast). Antifungal ointments containing cortisone are often used for severe inflammation. Oral use of the antifungals is also possible if necessary.

Oral drugs are usually also used to treat parasitic infections, although special antibiotics have also proven effective against the Trichomonas vaginalis pathogens. In viral inflammation of the glans, external antivirals are generally used.

Ultimately, however, the drug treatment approaches for the viral forms of balanitis are rather limited, since the corresponding preparations do not work as efficiently as antibiotics for bacterial inflammation. For all forms of infectious inflammation, the sex partners of those affected may also have to be treated accordingly, which is why they should also be able to be examined by a doctor.

Therapy of non-infectious glans inflammation

In the particularly widespread balanitis simplex, the symptoms or the inflammation symptoms are usually used with externally applied, slightly cortisone-containing preparations. At the same time, it is important to avoid renewed skin irritation as much as possible in order to facilitate healing and to prevent repeated occurrence of the glans inflammation.

If Reiter's disease is the basis of balanitis, non-steroidal anti-inflammatory drugs (NSAIDs) taken by mouth are used to relieve the symptoms. For severe forms of reactive arthritis, corticosteroids (corticoids) are also used. Chronic forms may require the use of immunosuppressants to manage the inflammation symptoms.

In the case of acorn inflammation caused by psoriasis, skin care products (emollients), increasingly external vitamin D preparations and possibly corticoids are used. There are also other medicines specifically approved for the treatment of psoriasis, which also have an effect on psoriatic balanitis. In view of the complex aetiology (disease development) of psoriasis, aspects such as nutrition or psyche are often taken into account as part of the treatment, as there may be possible connections.

If the skin disease is caused by lichen sclerosus, the external use of highly effective glucocorticoids is usually used. In particular, the anti-inflammatory and anti-allergic agent clobetasol propionate is increasingly being used to treat non-infectious, inflammatory skin diseases. Fatty and moisturizing ointments are said to help alleviate the symptoms and slow the course of the disease. If the course of the disease threatens to restrict the foreskin, circumcision may be necessary, also to avoid secondary infection.

If there is an underlying lichen lichen (lichen planus), the therapy is usually based on a procedure similar to that of lichen sclerosus: high-potency glucocorticoids are used externally and foreskin complications are circumcised.

With plasmacellular balanitis, circumcision is often unavoidable in order to permanently prevent the pathological multiplication of the germs under the foreskin. In general, it is important to eliminate the warm and humid environment. Adequate genital hygiene is also imperative. After washing the limb, this should be dried extremely carefully, but thoroughly. Glucocorticoid preparations that are applied once or twice a day can also help to alleviate symptoms and accelerate healing. However, these should only be used for a very limited time. If necessary, antibacterial ointments can also be used.

Gangrenosa balanitis is usually treated with a combination of antibiotic therapy and surgical removal of the affected tissue, which - depending on the severity of the disease - can be a very extensive procedure. If the necrotized tissue is not completely removed, there is a risk of inflammation recurring and extensive skin loss. At worst, the disease can be fatal.

Naturopathy for acorn inflammation

Naturopathy offers different approaches against the different forms of balanitis. In accordance with the holistic view of the symptoms, factors such as the acid-base balance, the intestinal flora and the psychological situation of those affected are also taken into account as part of the treatment.

In the case of infectious glans inflammation, measures that generally strengthen the immune system may be appropriate. Penile baths, for example with Kamillosan, as well as creams and ointments based on plants, with anti-inflammatory and antibacterial effects, are also often part of naturopathic therapy.

Accompanying homeopathic remedies (e.g. Arnica, Calcium fluoricum, Hepar sulfuris or Thuja) can be used against the inflammation, but the selection should be reserved for experienced therapists.

Although naturopathy has a wide range of therapeutic approaches against the various forms of balanitis, those affected are not spared antibiotic therapy in the event of severe courses and impending complications, and surgery may be required. Here, the naturopathic procedures can often be used as an adjunct or after the intervention and contribute to relief. (fp, nr)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dipl. Geogr. Fabian Peters, Barbara Schindewolf-Lensch


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ICD codes for this disease: N48ICD codes are internationally valid encodings for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.

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