Posthitis (pronounced pos-THI-tis) is the inflammation of the foreskin (prepuce) of the penis. It is characterised by swelling and redness on the skin and it may be accompanied by a smelly discharge. The term posthitis comes from the Greek "posthe", meaning foreskin, and "-itis", meaning inflammation. Causes
Posthitis can have infectious causes such as bacteria or fungi, or non-infectious causes such as contact dermatitis or psoriasis. The inflammation may be caused by irritants in the environment. Common causative organisms include candida, chlamydia, and gonorrhea. The cause must be properly diagnosed before a treatment can be prescribed. A common risk factor is diabetes. Posthitis can lead to phimosis, the tightening of the foreskin which makes it difficult to retract over the glans. Posthitis can also lead to superficial ulcerations and diseases of the inguinal lymph nodes. Prevention
Hygiene, in particular the regular cleaning of the glans, is generally considered sufficient to prevent infection and inflammation of the foreskin. Full retraction of the foreskin may not be possible in boys younger than about ten years and some may not be able to fully retract their foreskin for cleaning until their late teens. Treatment
If contact dermatitis is suspected, soaps and other external irritants should be discontinued and a latex allergy should be investigated. The treatment depends on identification of the cause. Irritants in the environment should be removed.
However, in spite of the fact bicalutamide is metabolized by CYP3A4, there is no evidence of clinically significant drug interactions when bicalutamide at a dosage of 150 mg/day or less is co-administered with drugs that inhibit or induce cytochrome P450 enzyme activity.In-vitro studies suggest that bicalutamide may be able to inhibit CYP3A4 and, to a lesser extent, CYP2C9, CYP2C19, and CYP2D6. Conversely, animal studies suggest that bicalutamide may induce cytochrome P450 enzymes. In a clinical study, bicalutamide co-administered with the CYP3A4 substrate midazolam caused only a small and statistically non-significant increase in midazolam levels (+27%) presumably due to CYP3A4 inhibition. However, this was well below the increases with potent CYP3A4 inhibitors like ketoconazole (+1500%), itraconazole (+1000%), and erythromycin (+350%), and is considered to not be clinically important. There is no indication of clinically significant enzyme inhibition or induction with bicalutamide at doses of 150 mg/day or below.Because bicalutamide circulates at relatively high concentrations and is highly protein-bound, it has the potential to displace other highly protein-bound drugs like warfarin, phenytoin, theophylline, and aspirin from plasma binding proteins. This could, in turn, result in increased free concentrations of such drugs and increased effects and/or side effects, potentially necessitating dosage adjustments. Bicalutamide has specifically been found to displace coumarin anticoagulants like warfarin from their plasma binding proteins (namely albumin) in vitro, potentially resulting in an increased anticoagulant effect, and for this reason, close monitoring of prothrombin time and dosage adjustment as necessary is recommended when bicalutamide is used in combination with these drugs.