?Id reaction/penile rash

[shane2812]

I have written twice before about a constellation of symptoms- eyelid dermatitis, mild flexural eczema, erythematous patches on the shaft of my penis that itch, with red papules concentrated in the distal glans, + a "disydrotic" eczema on the dorsum of right first digit.  All of these come together, penis first.  The finger is the last to heal.  The symptoms develop after my female partner and I have been together for awhile (days to weeks) and resolve when we separate (after about 2-3 weeks).  Everything responds somewhat to desonide, and I haven't tried antifungals alone.  The eyes and penis itch.

So, I have been wrestling with this for a long time and thinking of it as the introduction of an extrinsic trigger which was flaring up my eczema (even though I haven't had any for twenty years).  But what if I am getting infected with an antigenic trigger from my partner and the other stuff is all part of an id reaction.  The rashes all come back in exactly the same places, including the finger, looking exactly the same.  Food and stress do seem to have effects, but I couldn't elicit the symptoms no matter how much **** I ate or how stressed I was while my partner and I were apart.

So here are my questions...
1.  What is the differential of an infected shaft/glans besides Candida with the appearance mentioned above?  Bacteria?  Dermatophytes?  It does seem that my partner's vagina gets more irritated and "yeasty" concurrently with all this.

2.  Exactly how would I go about identifying the antigenic trigger/infectious agent if this was the case?

3.  If this is the case, exactly how would my partner and I treat this condition....say, if it is Candida?

Thank you for your thoughts.

Shane MD MA
pager 573-443-9354

[Alan Rockoff, MD]

As I think I've said before, I think all your symptoms are eczema, just plain eczema.  They recur in the same places because eczema likes those places, among others.  I don't know why.  Sex can aggravate pre-existing eczema, but doesn't cause it.  The yeast hypothesis is popular in the alternative heath community, and is based on concepts and reasoning which doesn't translate into medical ones.  (The same is true of the conviction--a belief, really--that there just absolutely has to be a trigger for every variation in health.)  If you want to follow that line of thinking, you could have your girlfriend cleanse her GI tract by taking anti-yeast pills, and you could treat your own skin with an anti-candida agent like OTC clotrimazole.  But if, as I expect, nothing much happens, you'll need to confront the fact that eczema just happens--you treat it, and move on.

Best.

Dr. Rockoff