What topical treatments are recommended for managing balanitis, and how should I advise patients on their use?

Topical treatments for balanitis are recommended based on the likely underlying cause:

• Non-specific dermatitis: Prescribe topical hydrocortisone 1% cream or ointment once a day until symptoms settle or for up to 14 days ¹. Additionally, prescribe an imidazole cream, with the frequency depending on the preparation used, until symptoms settle or for up to 14 days ¹.
• Irritant or allergic contact dermatitis: Prescribe topical hydrocortisone 1% cream or ointment once a day until symptoms settle or for up to 14 days ¹.
• Candidal balanitis: Prescribe an imidazole cream, with the frequency depending on the preparation used, until symptoms settle or for up to 14 days ¹. If marked inflammation is present, consider prescribing topical hydrocortisone 1% cream or ointment for up to 14 days in addition ¹.
• Bacterial balanitis (mild infection): Consider using a topical antibiotic preparation such as mupirocin 2% ointment 2–3 times a day for 7–10 days ¹. If inflammation is causing discomfort, consider prescribing topical hydrocortisone 1% cream or ointment for up to 14 days in addition ¹.

When advising patients on their use, include the following:

• Good Daily Hygiene: Advise patients to wash daily with lukewarm water ¹. Where possible, they should keep the foreskin retracted until the glans penis is dry ¹. Patients should avoid irritants such as soap, bubble bath, or baby wipes ¹. Consider recommending the use of an emollient as a soap substitute ¹. For children, advise not to attempt to retract the foreskin if it is still fixed ¹.
• Avoiding Triggers: For suspected irritant or allergic contact dermatitis, advise patients to avoid any suspected triggers (e.g., soap, bubble bath, latex condoms, lubricants, or creams) ¹.
• Application and Duration: Topical hydrocortisone 1% cream or ointment is typically applied once a day for up to 14 days or until symptoms settle ¹. Imidazole creams are used until symptoms settle or for up to 14 days, with frequency depending on the specific preparation ¹. Mupirocin 2% ointment is generally applied 2–3 times a day for 7–10 days ¹.
• Review: Advise patients that a review should be arranged if symptoms are severe or have not improved following initial treatment ¹. If topical hydrocortisone has been used, it should be stopped at this point ¹.