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Dermatitis on penis
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Dermatitis on penis

I thought I would post this here because my issue is both urological and dermatological (at least I think it is).

The full story behind my condition can be found here: http://www.medhelp.org/posts/show/482051
I shall quote the important part here:
--I dropped out of school last semester due to depression and financial issues and after dropping out I basically did not take care of myself too well for around two months.  I showered on average once a week or two and was a mess.  During this peroid of not bathing I developed a rash on the head of my penis.  The rash is basically where the foreskin covers the head of my penis, and the rash is not on the entire head but only where the foreskin usually covers it.  The purple 'edge'/end of the head near the shaft, however, was not affected.  The rash had an itch to it when I tried to masturbate.  When I noticed the rash and itch, I started showering daily to keep my penis clean and I kept my foreskin retracted at all times, thinking it would be best to keep the area dry all the time.  The itching eventually went away after a week or so.  I believe there was a small rash on the foreskin that went away about when the itching stopped.  The rash on the head did not go away along with the itching.  The rash has been basically the same ever since it popped up, minus the itching.  It's been there for over a month now, with no change.  Recently I used 1% clotrimazole cream on my penis for 5 or 6 days, thinking it was a yeast infection, but this did not seem to do anything.  I then went out and bought a 3-day Monistat set and have been using the 2% miconazole topical cream that came with the vaginal creams for two days now, and I haven't noticed any change either.  I have been keeping the foreskin retracted all the time.
I would say that the rash has a definite border to it.  Before I started using the antifungal creams, on two or three occasions I noticed that the rash had these sort of small cracks and was white, as if it was drying off/going away, but it did not go away a few days after I noticed this.  It is redder than the unaffected parts of the head.  The rash seems to have almost the same texture as the regular head.  It is red but NOT swollen; looking from the side, the penis has its regular shape.  Also, the rash is not a 'consistent' rash; by this I mean that there are sections among the rash where there are 'slivers' and a spot of regular-looking glans (glands).
I can try to post a picture of it if it is allowed here and if it will help.
--

So, I went to see a urologist and she said that what I have is contact dermatitis, possibly caused by laundry detergent.  I've washed my clothes with detergent without dye/perfurms and just water now after I found this out.

The day after seeing the urologist, I went to see my regular doctor, and he said something along the lines of it being irritation/dryness that's causing it and prescribed lotrisone, which is a combination of clotrimazole and betamethazone.

My questions:
Is lotrisone the right thing to use for my condition?  The 1% clotrimazole cream I used earlier didn't work.  What effect will combining clotrimazole with betamethasone, a glucocorticoid steroid, have?  Should I instead just use OTC hydrocortisone?  Do these glucocorticoid steroids actually do anything to get rid of the rash, or do they just temporarily relieve itching/redness?  Should I see a dermatologist about this?

Thanks,
Tom.
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18 Comments Post a Comment
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Avatar_dr_f_tn
Hi,

I do understand your concern about this. As this is related to your condition, may I ask if you are circumcised?

This sounds like a case of balanitis. Balanitis may be due to several factors.It may be caused by infectious agents like bacteria and fungal infections. Mechanical injury may cause dermatitis and psoriatic lesions.In your case,this appears to be an allergic or irritant balanitis. This type of balanitis is due to an underlying allergic reaction to certain triggers.

A combination of an antifungal and steroid may help relieve the itchiness and redness of the affected area. If this is a fungal infection it should readily be resolved by using an antifungal.However, in most cases there may be an underlying infection to a dermatitic condition and vice versa. This prolongs the condition and makes it more resistant to usual medications.

Combining a steroid with antibiotics and antifungals helps alleviate any underlying inflammatory condition  aside from targeting organisms alone. Hydrocortisone is a mildly potent steroid and may be used on the genitals .However, at this point I suggest that you follow your physician’s advice and seek follow up to have your response assessed.
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Avatar_m_tn
I am not circumcised.  It is balanitis.

Should I even be taking the steroid and antifungal combo if the antifungal by itself did nothing?  There isn't any itch or discomfort or swelling, it's just red.
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Avatar_m_tn
I used the betamethasone for the seond day today with no change from the last day.  How long should it take for this to clear up?
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Avatar_dr_f_tn
Hi,

Continue using the betamethasone cream for at least a week just to be able to assess your response to the medications. Most skin conditions respond to corticosteroids. Both dermatitis and fungal infections respond to this. Another form of balanitis is psoriatic dermatitis and this also responds to corticosteroids. Psoriatic balanitis is not uncommon and the penis is a site that psoriasis usually affects. This is a differential for your case.

Do you have any similar rash in other parts of the body? Psoriatic rash does not necessarily present with scaling.

Continue using the medication. Using it for only a day is not enough to assess the effectivity of the drug in your case.
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Avatar_m_tn
Hi
I posted a picture of the rash but the post seems to have been deleted so I'll try to post it again as an attached and reviewed picture later.

I am on the third day with the betamethasone with no change.  I will continue with the betamethasone for a week or so, thank you for the information.  I think I'll go back to my doctor in a week.
I do not have any other rashes on my body.  There is no history of psoriasis in my family that I know of either.
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Avatar_m_tn
Day 4 with still no change.
Today I noticed that the area where I've applied the betamethasone seems to be more sensitive to touch.  Is this normal?

Also, what makes the surface of the glans (glands) different from regular skin?

Is the betamethasone supposed to assist in the 'reepithelialization' of the surface of the glans (glands) to its normal state?  Why does it take many days/over a week for the condition to respond to betamethasone/corticosteroids?  I think what I'm asking is: what occurs on a cellular/molecular level when the corticosteroid is applied?
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Avatar_m_tn
Also, what does the fact that there was a weak itch when the rash first appeared but went away after a week suggest/say about what this could be?
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Avatar_dr_f_tn
Hi,

What makes the skin of the glans (glands) different from that of other parts of the body?

"The glans (glands) penis is the expanded cap of the corpus spongiosum. It is moulded on the rounded ends of the Corpora cavernosa penis, extending farther on their upper than on their lower surfaces. At the summit of the glans (glands) is the slit-like vertical external urethral orifice. The circumference of the base of the glans (glands) forms a rounded projecting border, the corona glandis, overhanging a deep retroglandular sulcus (the coronal sulcus), behind which is the neck of the penis. The proportional size of the glans (glands) penis can vary greatly.

The foreskin maintains the mucosa in a moist environment.[5] In males who have been circumcised, but have not undergone restoration, the glans (glands) is permanently exposed and dry. Szabo and Short found that the glans (glands) of the circumcised penis does not develop a thicker keratinization layer.[6] Studies have suggested that the glans (glands) is equally sensitive in circumcised and uncircumcised males.[7] [8]"

Source: http://en.wikipedia.org/wiki/Glans_penis

Based on the above paragraphs, the glans (glands) does not develop a thicker keratinization layer which makes this part of the penis highly sensitive. Skin in other parts of the body is keratinized which gives it is slightly rough and dry feel. The glans (glands) is mucosal in its surface as it is an extension of muscular tissue called the corpora spongiosa.

Is betamethasone supposed to assist in reepithelialization?

As far as I know, corticosteroids are more notably known for their antiinflammatory effects and this is prescribed for your condition to alleviate the redness, swelling or itchiness that come with it. Reepithelialization, as far as I know, is not the primary action of the betamethasone.

In the molecular level, corticosteroids are supposed to inhibit prostaglandins .Prostaglandins play a pivotal role in the inflammatory pathway. Corticosteroids disrupt this pathway and inhibits or activates other proteins responsible for the inflammation.

With regards to the use of your medication, here is a url that may help.

http://www.medhelp.org/drugs/show/4540






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Avatar_m_tn
Hi,
First of all, thanks for being so helpful/resoureful with me.

The idea I had was that the betamethasone/corticosteroids inhibit the inflammation and allow the surface of the glans (glands) to reepithelialize normally without inflammation, but I guess this is wrong?  Does the glans (glands) surface have to 'shed' off the current inflammed surface and create a new one?  I don't know if I'm making much sense here.
I'm guessing that the effect of the corticosteroid depends on the cause and type of inflammation.

I think I should add this:  A day or so before going to the doctor, when I was not using any creams or medications for a few days, I again noticed that the rash was drying/cracking and I managed to peel some off with my fingernails.  The rash stayed the same after this appeared.  It has not changed its shape at all since I began closely monitoring it, which I have been doing for about a month now.



The top was taken right after waking up, the second about 30 minutes after applying the lotrisone.  I've edited it down so that you can only see the affected area and nearby regular tissue.  Hopefully it doesn't get deleted!  I don't think anyone can really tell what exactly is in the picture without knowing about my condition.
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Avatar_m_tn
A comment on the texture of the rash:  It has a slightly different texture than the unaffected areas.  I just ran my finger over it after washing and drying the area, and I noticed that it was smoother than the regular parts.
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Avatar_m_tn
I called up my doctor today and he said that I should use it for another week if it doesn't go away after the first week (I'm on day 6 now), and his idea was that this it will take long for it to clear up since I've had the rash for over 2 months.
He didn't have much time so I couldn't ask about the questions I asked in my last posts.

Is it safe to use corticosteroids on the genitals for such periods?
What should I expect if nothing happens after another week?  Should I go visit a dermatologist?  What could it be if it doesn't respond to corticosteroids?

And it looks like pictures of genital conditions are not allowed here.  I guess the only way to share such pictures would be through private messages then?
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Avatar_dr_f_tn
Hi,

Yes, probably the images have been edited.

With regards to the use of the corticosteroid on the genitals, I believe that two weeks will be adequate. If there is no response noted after  this ,then a consult with a dermatologist may be done. Just remember that you apply the medication thinly and sparingly over the area.

No response to the medication may mean that the working diagnosis for the condition needs to be reassessed . In your case, the diagnosis was not fully established but based on what you are given your physician may actually be thinking this is a fungal infection with dermatitis.

You may opt to visit your dermatologist early on. He/she may help you assess your response to the medication.
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Avatar_m_tn
Today I made an appointment with a dermatologist on next friday, giving me some time to cancel if the condition improves before then.

Is it possible to have psoriasis appear only on the genitals?  I'm starting to think that that's what I have since the images I've seen of it (first image on google image search for 'psoriasis penis' with safesearch off) look a lot like what I have.  It seems that the original infection, when I still had the weak itch, has gone away but the skin has been affected by it.  Does this make sense?
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Avatar_m_tn
OK, for the last two days I have been applying a thinner layer to the affected area and spending more time on rubbing it in with my finger rather than just applying it and letting it dry.  I've noticed that since I've started this, the rash has become a slightly less red and a bit closer to the regular color.  Not sure if this is a mere coincidence or if they are related.

The rash has a sort of smooth and almost waxy feel to it - I don't remember if it was like this before.  Do betamethasone/corticosteroids cause this?
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Avatar_dr_f_tn
Hi,

With regards to the psoriasis,it is possible that this may be localized in the genitals.

"Psoriasis may affect the penis, particularly the glans (glands) penis. Thin pale erythematous
plaques with slight scale are seen in discreet or continuous forms. No itching or burning is present.It may be aggravated by trauma. Often, no psoriasis is seen on the rest of the body."
(http://members.aapa.org/aapaconf2005/syllabus/5025GoldmanGenitaliaDerm.pdf)

I believe the rash is improving. You have noted it is less red now .The steroid may have this effect on the skin. You may opt to have this assessed by your physician. How long are you into the medications?


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Avatar_m_tn
Thank you for that link!  Very informative.  Psoriasis seems to be the closest to what I have.
The document mentions this:
"Many clinicians feel that candida helps precipitate psoriasis in susceptible individuals."

What makes a person susceptible to it?


This morning it was as red as it was on all other mornings, but throughout the day I've been monitoring and it seemed to be generally less red than usual.

I'm on day 9 with the lotrisone.  I have an appointment with a dermatologist but I might cancel it if the rash continues to improve.
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Avatar_m_tn
Pyrithione zinc, the active ingredient in dandruff shampoos, is used to treat dermatitic conditions.  Would using such shampoo for the rash do anything?
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Avatar_dr_f_tn
Hi,

Susceptibility may not be measured or determined readily when it comes to psoriasis. It is an autoimmune condition with some genetic factors involved. A family history of psoriasis increases the risk for psoriasis with the odds of getting the condition at 18 times more if one or both parents have it. Some studies have shown that risk for developing psoriasis increases if one smokes greater than 15 sticks of cigarettes per day.

Source:http://www.ncbi.nlm.nih.gov/pubmed/1390163

I suggest that you still follow up with your physician once the course of applying the cream has been completed. This will provide you with a more objective assessment.
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