Rash/spots on penis head

[thatguy14]

Doctor,

I am having a problem with recurrent rash/spots on penis head, that usually comes with masturbation/friction, although, I think very few times, it came without any reason. The rash is itchy.This has been going on at least from past 8 to 12 months.

Sexual history : I am 37 year old male, with no sexual partner from past 1 year. I have had multiple sexual partners before that.

I went to a primary care doctor 2 weeks ago, she thought it could be dermatitis, she also did a herpes swab test which came back negative. she didnt see the need to do a blood test. I have been using 1% Clotrimazole cream and 1% Cortizone cream on a daily basis from past 2 weeks.

Please go through some pictures:

May 1: http://i60.tinypic.com/2n87fwz.jpg (A day after masturbation)
May 2: http://i59.tinypic.com/rbeh5s.jpg
(2 days after masturbation, a swab is taken when it
looked like this, herpes culture came back negative)
May 10 : http://oi57.tinypic.com/n5fqsy.jpg (Rash seemed to heal)
May 17 : http://oi62.tinypic.com/qzki8y.jpg
( 2 New spots appear at different locations, one to the top left, another at bottom right).

I am worried about the two new spots that suddenly appeared today(May17), I haven't masturbated or had sex from May 1st. I am not sure why the spots appeared all of a sudden.

I stopped worrying about herpes, but this puts that question back in my mind.
should i get a blood test? Please advice.

Thanks

[Bhupinder Kaur, MD]

Hello,
Thanks for posting your query.

I have checked the photographs and can understand your concern for these rash like spots on penis head. From the symptoms and photographs, these are less likely to be herpes sores. Moreover the herpes swab test was negative. Most individuals have no or only minimal signs or symptoms from HSV-1 or HSV-2 infection. When signs do occur, they typically appear as one or more blisters. The blisters break, leaving tender ulcers (sores) that may take two to four weeks to heal the first time they occur. Typically, another outbreak can appear weeks or months after the first, but it almost always is less severe and shorter than the first outbreak.

Since the rash is non painful and presenting as patches rather than blisters, chances of herpes are less likely. If you want to get investigated then you can get the blood tests for herpes HSV2 done to completely rule it out.

Your dermatologist is right that it can be dermatitis skin. However another possibility which needs to be ruled out is of lichen planus penis head. It is an itchy skin rash which can occur on the penis in men and the typical skin rash may affect the glans of the penis. It presents as shiny, 3-5mm, slightly raised purple-red spots or a rash with white streaks. It may also cause white ring-shaped patches.

Usually it is diagnosed by physical examination but to confirm the diagnosis, a biopsy of the skin may be done by a dermatologist. This will confirm the diagnosis and also rule out other similar lesions like dermatitis skin, lichen simplex chronicus or eczema.

Hope that this information helps and hope that you get better soon.

Wishing you good health.

[thatguy14]

Dr. Kaur,

I got my Blood work for Herpes ICG/IGG . Both comeback negative. the second Herpes culture came back negative too.culture for bacteria came back negative.

about the rash/spot, it healed completely by itself. Although i occasionally experience some itching.I am applying 1% Clotrimazole cream when it itches.

based on my pictures, my negative blood and culture tests. can i be confident that this is not herpes? I am inclined to think that this probably caused by friction and/or bad hygiene.

I appreciate your help. Thanks

[Bhupinder Kaur, MD]

Hello,

Thanks for writing back to me. I have checked the photographs and lichen planus is one possibility. However your dermatologist is right in sending the samples for yeast infection as there is a possibility of fungal skin infection on account of the lesion being itchy.

If the KOH examination of the skin sample comes negative then get a skin biopsy done from a dermatologist to confirm the diagnosis and rule out lichen planus.

I sincerely hope that helps. Take care and regards.

[thatguy14]

Dr,

I would really appreciate if you respond to this one question/Update.

This is how the spot looks today
(May 20):http://oi60.tinypic.com/2rggvlx.jpg
It looked like this on May 17th (when it appeared) :
http://oi62.tinypic.com/qzki8y.jpg

does this look like lichen planus at all? (I am hoping it is).There is mild white/yellowish border to the lesion.As I mentioned earlier, it itches..and has a burning sensation.

I went to again primary care physician (Not Dermatologist). He did another swab test for herpes and yeast. also ordered blood tests. He didn't say anything about lichen planus. he also gave some antibiotics in the mean time.

I am anxiously waiting for blood work. your answer is very very appreciated.

Thanks

[thatguy14]

Dr.Kaur:

Thanks for your response. I am specifically concerned about the the 2 spots in this picture :
May 17 : http://oi62.tinypic.com/qzki8y.jpg

I apologize, English is not my first language, I am thinking these look like 'blisters'. They are not painful but a little itchy.

Are you saying this doesn't look like typical herpes?

I am an anxious person, I thankyou very much for your patience.

[thatguy14]

FYI, I got cleared of all the regular STDs a month ago, I didnt get herpes test done. Thanks