persistent burning (probable) fungal infection on penis

[mirvus]

i've got a rash/burning sensation on my penis that positively REFUSES to go away.  after going to my regular doctor several times, a urologist and two different dermatologists, it's been narrowed down to very likely being a fungal infection (though a biopsy has yet to be done - i don't know what it is doctors have against doing a skin-scrape for confirmation).  so far i've tried an over the counter monistat cream (applied twice daily for two weeks), lotrisone cream prescribed by my GP twice a day for two weeks, vytone cream prescribed by the first dermatologist twice a day for two weeks in addition to nizoral tablets once a day for 20 days, keflex 3x a day for 10 days as prescribed by the urologist, even though he didn't see any infection, he gave it to much as a "just in case," and finally nizoral 2% cream as prescribed by the second dermatologist.  

nothing seems to work, though i may be inpatient on the nizoral cream as i've only been using it for 2 days now.  the doc said i should notice a "marked reduction in symptoms within 2-3 days," but the degree of the burning hasn't changed and the rash hasn't receded or lightened.

also, this worries me the most i think, because the rash is spreading.  initially, back in late november, i just noticed the skin immediately around the urethral opening looked red/irritated.  by january, there was a very well defined red area on the top center of the head of my penis about the size of a thumbprint, and now the red area covers between 1/2 and 2/3 of the head on the center and right side.  as i said, it's a very defined area, it's not splotchy or just "here and there."  the rash isn't scaly or itchy or weepy, there's no white flakes which would be characteristic of dermatitis, it's just simply a shade or two redder than the unaffected skin.

anyway, as i was saying, the red rash and burning falls directly into a yeast infection type of skin condition (so far as i can tell, based on internet research), and the second dermatologist agreed with as much that it was very likely a yeast-induced infection.  there aren't really any other conditions that seem to fit my symptoms.  but everything i've read indicates that yeast infections - while they may be chronic - are easy enough to get rid of.  you apply cream for 2-3 days and there it goes.  this isn't chronic, this is Constant.  it hasn't wavered a single time in four months of attempted treatments - the burning stays basically at the same level, though some days are worse than others, but the rash is very steadily spreading.

anybody ever experienced anything like this?  or have any suggestions or input?  anything is appreciated.

[mirvus]

also, thank you for the response, doctor.  i will be making another appointment with my dermatologist soon.  the last time i saw him, he seemed to think it was sebhorreic dermatitis, but i don't think i'm showing any real symptoms of that - no white flaking, no itchiness, and the nizoral cream should have controlled that by now, shouldn't it?

[mirvus]

well, the nizoral 2% cream i had only been using for 2 days at the time of my last post, after about  4-6 days, the burning dropped off almost entirely.  in the span of nearly three weeks, only one day did i feel any burning, and it was very mild compared to what it had been.  the rash itself seemed to be getting very, very slowly back to normal skin color, but in the past four days, the rash around the tip of my penis has become a very pinkish-red, and the burning returned last night/tonight.  i have been using the nizoral 2% twice a day for not quite four weeks now, never missing a single dose - i thought for sure it was slowly curing it, but now the burning and rash are back despite my still using it.  i don't understand what this could be.  it's more persistent/longer lasting than any rash i've ever heard of.  i'm starting to get worried.

[Bhupinder Kaur, MD]

Hello,
Since you have sued so many antifungal creams and taken so many antifungal oral drugs, so the diagnosis needs to be reconfirmed. It can be a fungal infection but the other possibilities of eczema or dermatitis also need to be ruled out. A KOH examination of the skin scrapings and biopsy skin can help in confirming the diagnosis.

It is very difficult to precisely confirm a diagnosis without examination and investigations and the answer is based on the medical information provided. For exact diagnosis, you are requested to consult your doctor. I sincerely hope that helps. Take care and please do keep me posted on how you are doing.