Dry penis skin, new lumps

[thetemp3]

For eight weeks I have been experiencing genital discomfort ranging from minor pain to itching. I visited an STD clinic, where I received an antifungal creme (Clotrimazole and steroid) "just in case". After two weeks on creme, my penis skin has been dry and slightly leathery in parts. After masturbation, head and upper shaft appear white and flaky until washed. Also, rim of the glans appears red and highly chafed at all times. I have switched from soap to Cetaphil cleanser, and this seems to be helping, but is there any other treatment you would recommend?

Also, after 8 days using the creme, I noticed a red lump on the lower right side of the meatus. The lump is generally a millimeter in diameter, slightly raised. and usually only noticable when the urethra is stretched open. It has appeared irritated (slightly larger, redder) on two or three occasions since. Had two genital inspections since: first doc did not appear to notice the lump, second had to have it pointed our, said it was possible it was a genital wart but unlikely (small, unusual location). The lump remains in place, and I have noticed another, smaller red lump on opposite side of the meatus (not sure if it was there to begin with or not). Could this be normal penile anatomy, creme related, a wart, or something else?

Finally, today I noticed flesh-colored bumps on the underside of the penis shaft. They are very small (only visible when erect, and then less than a millimeter diameter), and resemble goose bumps; but they are clustered in an odd fashion, and located near a somewhat "bruised" looking part of the shaft, where I had noticed an inflamed-looking, slightly swelled line tracing about an inch up the shaft (when skin pulled taut). I know herpes is highly unlikely at this time (8 weeks since possible infection), but with general itching and irritation I am concerned. Could herpes blisters become visible only during erection? Can they present this late?

Thank you very much for your time.

[Alan Rockoff, MD]

I think you probably have penile eczema (the irritated part).  That should respond to a low-potency cortisone cream plus minimizing friction and liberal use of moisturizers.  The other changes are probably normal anatomy that you never looked closely at before.  This is certainly true of the goose-bump-like spots you describe.  I'd follow up with the doctors you've been seeing, but basically I think the less you do, the better off you'll be.

Take care.

Dr. Rockoff