Penis Rash - Recurrent

[Healthquester]

For about a year I have had a rash that continues to show up on my glans penis.  It is a very strange red rash that used to sort of concentrate around the Urethra but now seems to have generalized around the the glans.  It used to hardly ever be visable until after sex when a subtle red rash would appear.(a year ago, and sometimes it mostly goes away to this point)  Now the red rash is visable all the time and after any friction it is very apparent.   I have searched images on the internet endlessly to identify this and the closest thing I found was psoriasis.  The rash gets much more apparent after any friction – including sex, masturbation, or just clothes rubbing at night, sometimes I get an erection in the morning because I have to pee and that seems to really make it worse.  It doesn’t itch it’s more of a burning or pinching type of sensation.  Sometimes it seems to go into the Urethra but I’m not sure.(seems like it used to but lately it’s been a mild rash on the glans.  It will almost go away at times but as soon as a friction even occurs it comes back.  I feel like maybe there is some scar tissue building or something as it almost seems like very small skin tags are developing.  I have been dealing with this for over a year, initially it wasn’t bad but seemed to be concentrated near the Urethra.   I tried some pretty radical self prescribed treatments like cleaning with Betadine, because I thought it was a fungal or bacterial infection.  I have also tried Monistat(which made it worse)  Protopic(which I think may help a little) and recently I’ve applied a vitamin D cream which also seemed to provide some relief.    I’m concerned that I misdiagnosed and complicated the problem.  I do have HSV2 but I don’t think this is related as that looks much different and affects a different area, but it did come about shortly after the HSV2, possibly because my initial response to the HSV2 infection was to cleanse the area vigorously with things like Betadine(and Dynimaclear which has some sort of sulfur compound) as I thought it was a microbiological infection.   I do have a history of psoriasis in my family but I have not shown any symptoms that I know of.  I thought maybe HPV as I have been dating women from Herpes dating sites, and it's pretty common for some to have HPV as well.

I have never had any discharge from my urethra, but sometimes it looks red inside and I think I can see a little sore in there.  Mostly the problem is on the head of the penis but there has never been anything on the shaft.  My HSV2 outbreaks however have been on the shaft and never on the glans.  Any theories would be appreciated.

[people17]

Im experiencing the same problem at this moment..sincerely hoping a solution to cure this condition..as what u suspect, lichen planus or psoriasis maybe more possible i think..any dermatology please give a clue..thankyou very much.

[lgs2783]

I have also been experiencing a very similar thing for the past 4 years except that I have never had HSV. It has been near impossible to find any information on anything that even resembles this. It has been very frustrating to say the least, and any time I find a discussion like this it seems to just die without anyone offering anything conclusive! If anyone has any answers please don't leave us in the dark!

[jay277167]

I also have the same thing off and on for years with the severe rash, but most time when the rash is not there i feel like its not ok in my groin area. Just spent $500 on STI test all negative not sure what to do..I got this after my first hSV2 out break in 2001 and then it would go from my eyes to my penis. Any help would be good.

[dpoland266]

I've got the same thing!  my urologist went down a Jock itch route and after using a couple creams its still getting worse.  Have you found anything else out???

[Healthquester]

Thank you for your last response Dr. Bhupinder.  I have taken your advice and gotten a full STD panel done excluding HPV, all except HSV2 (which I've known about and doesn't resemble this) came back negative.  

I have now seen a few different dermatologists, the one I have spent the most time with assured me that he could help me figure out what the issue was.  So far I have spent over $1000 dollars with him to get a biopsy, do a scraping, and several other tests.  Nothing has come back, no bacteria or yeast of concern(they said)  I have tried a few steroid creams(Hydrocortisone valerate .2%, Hydrocortisone butyrate .1% neither of them seemed to help, only Protopic has so far seemed to make any difference but this is slight and I am worried that it may be shutting my immune response down temporarily so that when I stop taking it the real problem bounces back worse, but I'm very unsure of that.  

The Dermatologist has assured me that this is not contagious but I think he's guessing about the problem having diagnosed it as some type of "dermatitis or balanitis."  He keeps prescribing me random cortisteroid applications stating that "eventually we'll find something that works"  and he wants me to keep seeing him.  Today he prescribed me Pramosone(hydrocortisone acetate 2.5% and pramoxine HCL 1%) I told him that the cortisteroids have had no effect and this doesn't itch it burns but promoxine as I understand is for itching.  So this seems like a bad call to me for the next step because there isn't anything in this that would likely work better than what we've already determined isn't working.  I am thinking that maybe I should try a systemic antibiotic for the next step.  I feel like he should take a look with a magnifying glass or something which might help him know what this is.  

Anyway it has been spreading and can be seen slightly on the shaft.  I've been sexually active with one partner who knows what I'm dealing with, and that seems to make it worse.  Possibly a latex allergy?  I don't know but masturbation has been just as bad on it possibly something in the lotion I use?  It seems to come up after friction and stays around for a long time.  I got desperate the other night and tried putting monistat 7 on it thinking maybe it was a yeast infection.  That made it inflamed...  Then I tried putting vinegar on it to see if it might possibly turn white from HPV.(which I haven't been tested for, and may be the only STD I suspect could be playing a role here.  

I just don't get it, I have strong skin everywhere else and rarely have any issues and I don't have diabetes.

Why doesn't this want to heal?  And why is it getting worse?  

My thought on the possible problems in order from most to least likely..

Psoriasis - my dad and grandma on moms side both have it pretty bad
Dermatitis - possibly seborrheic(although the description doesn't sound like it really
Contact or atopic Dermatitis - would have to be multiple things, friction, latex, lotions, soaps
Lichen Planus -  I haven't seen a case on the internet that looks much like this
HPV - I really worry about this one because it's the only STD I'm not sure about and I could be exposing my girlfriend...

Any thoughts would be appreciated.

[Bhupinder Kaur, MD]

Hello,
From the symptoms that you have mentioned, it can be rash due to friction rub or lichen planus. Lichen planus is an inflammatory disease that affects the skin and the oral mucosa, and presents itself in the form of papules(flat spots) or rashes. Treatment is available only on prescription and consists mainly of steroids, retinoids, hydroquinone and phototherapy.

My sincere advice is to consult a dermatologist and get it evaluated. Also get a complete STD panel tests done. I sincerely hope that helps. Take care and please do keep me posted on how you are doing.