Penile Psoriasis Treatment

[eric78]

I am a 25 y/o medical student.  My suspected penile psoriasis has been recently confirmed by a dermatologist.  I have had the problem for almost 5 years.  Having a pretty good idea of what I was dealing with from the get-go (since my father has moderate to severe psoriasis), I had been treating the problem with my father's triamcinolone 0.1% as needed, approx every 2-3 wks until lesion cleared (usu 2-3 days). This had been working well for many years in spite of the rebound effect and the fact that it would thin out the skin and make it more sensitive.  The frequency of lesions has increased in the last year as well as surface area (now anal and inguinal), so I visited the dermatologist.  He prescribed Dovonex ointment.  I notice that there is less of a rebound effect (i.e. I have to treat less frequently), but I've also noticed changes in surrounding skin, (i.e. whatever skin is in contact with the treated area).  From what I can tell, whatever the ointment touches causes redness and irritation that almost resembles psoriasis itself.  Have you heard of such a thing with Dovonex?  In addition to that, redness and change of general appearance of skin persists quite a while after the lesions have cleard.  The skin is highly sensitive to touch (uncomfortably so).  Is this an appropriate medication for the penis?



My main concern is that the mish-mosh (I've also experimented with Dermator 0.1%, Capex and T-Gel Shampoos, OTCs...) I've been applying on the penis is causing irreparable harm to the skin.  What is the best method of treatment for penile psoriasis?  The best schedule for doing so?  Is my prior use of medications causing the increased severity of psoriasis?  I would like to consider the future of my penis!  Presently, I can treat as needed and get good results.  However, I want to avoid having a non-functional and unsightly organ 10 years down the road as a result of what I'm doing now.  What is the best way to treat this psoriasis both short-term and long-term?



Also, to put the icing on the cake (and to complicate matters), I was also diagnosed with HPV 3 mos. ago.  I failed with Aldara and succeeded with Condylox.  Are there contraindications with the aforementioned medications?



Thank You SO much.

[Alan Rockoff, MD]

Triamcinolone, as a fluorinated steroid, is a bit strong for chronic use on the penis.  Dovonex is a medication I find of only modest effectiveness overall, and one which is likely to be irritating to sensitive penile skin.  The shampoos you've used are not appropriate for this region of the body.



You should be able to control psoriasis on the penis easily using a weaker steroid--Dermatop is OK, but generics like hydrocortisone 2.5% or desonide 0.05% are just as good.  Apply them twice a day until whatever spots are there become smooth and ignorable.  Then resume as needed only for as long as needed.  A newer option is the non-steroid Protopic ointment 0.1%  Worth a try, I would say.



HPV treatments can be administered as required.  The two sets of treatments shouldn't affect each other one way or another.



Take care.



Dr. Rockoff