difficult foreskin rash

Dear Dr. Rockoff,

For the past 6 months or so, I have been dealing with two different (though probably related) rashes.  One is a small red itchy rash in the crevasse of my butt, just above the anus.  The other is a red itchy rash covering the inside of my foreskin and the head of my penis.

I have been treated by a dermatologist numerous times for both issues, but neither problem seems to want to go away.  One doctor figures it is some kind of dermatitis and the second doctor I saw said it's probably inverse psoriasis.

I have used Desoximetasone 0.25% cream for a couple months at a time on each area (twice a day), which seems to help lighten it and help with the itching, but it comes back as soon as I stop treatment.  Even if it does lighten up, the skin is still shiny and kind of reddish and gets worse with friction (ie: sex) or if I stop using the cream at all.

I have had numerous Kenalog injections, including site injections and intramuscular injections (kenalog 10 and kenalog 40).  The shots didn't seem to help.  Most recently, a doctor prescribed Protopic ointment .1%, and all that did was help with the itching some, but it made my foreskin rash even redder and inflamed.  

I tried a fungus cream and oral fungal pills earlier on with my butt rash (before I had the foreskin rash), just in case but neither of those worked.  I am really starting to get frustrated.  The only thing that seems to have helped at all is the Desoximetasone, but since that is a strong steroid, I know it is not for long term use due to skin thinning side effects.

I figure the next step is probably a biopsy, but I want to avoid this at all costs.  Any suggestions?

Thank you.


This discussion is related to Red Rash, Itchy Skin .

[Bhupinder Kaur, MD]

Hello,
Since you have had this rash for quite some time and none of the medications, steroids and antifungals seem to be working, I suggest you to get a skin biopsy done. It can be a form of dermatitis but hardly looks like any fungal infection. Till then wear cotton clothes and change the clothes twice to stop irritating the rash.

I hope it helps. Take care and regards.

[nhaban]

Just an update for those who are interested.  I went to see my dermatologist today, and a biopsy was performed.  My doctor said he was stumped as to what it could be.  I will update everyone when I receive the results and my diagnosis.  

Thank you for the feedback, Dr. Kaur.

[nhaban]

I received my biopsy results back, and they found that I have a yeast infection (Candida).  My doctor is putting me on an oral medication (Ketoconazole) for 21 days and he also gave me a cream to use twice a day (Naftifine hydrochloride 1.0%).  Hope this works!!

[nhaban]

The Ketoconazole and Naftin treatment was not effective.  The doctor then prescribed Fluconazole 125 mg pills, one per day for ten days.  This was not effective either, so I will be going back in.  I'm not sure what is going on here.  It should be cured by now.