Dermatological Conditions Affecting the Penis - Causes, Symptoms, Diagnosis, and Management

Introduction

Male genital skin is a very common site for skin problems. A painful, distressing, and embarrassing situation for men, often interferings with their sexual functions, interpersonal relationships, and self-image. Hesitance and embarrassment due to penis skin conditions often result in delayed diagnosis and treatment of such conditions.

What Are the Signs and Symptoms of Penile Dermatological Conditions?

Penis skin conditions most commonly manifest themselves as;

• Itching and redness.

• Rashes.

• Pain.

• Swelling.

• Discharge from underneath the foreskin.

• Peeling of skin.

• Ulceration.

• Bumps or papules on the skin.

• Sore penis.

• Swollen lymph nodes in the groin.

• Foul smell.

• Painful urination.

• Areas of shiny and white skin on the penis.

What Are the Dermatological Conditions Affecting Penis Skin?

Penile skin conditions range from harmless rash to sexually transmitted diseases (STDs), making evaluating and diagnosing this condition of utmost importance. Inflammation of the gland is called balanitis. Posthitis is inflammation of the foreskin, and inflammation involving both the penis and the foreskin is called balanoposthitis. Men suffering from balanoposthitis have a higher chance of developing problems related to the penile foreskin. The chances of getting phimosis, paraphimosis, or penile cancer are also high. It can present as asymptomatic or associated with itching, pain, tightness of the foreskin, and sexual dysfunctions. Inflammation of the penile skin may be attributed to three main causes.

1. Infections: Bacterial, fungal, and viral infections may cause issues such as:

• Yeast infection.

• STDs.

• Scabies.

• Herpes simplex infection.

• Human papilloma viral (HPV) infection.

• Molluscum contagiosum.

• Viral warts.

2. Non-infectious Causes: Penis skin problems occurring from non-infectious reasons are:

• Allergic reactions to latex condoms.

• Pruritus is itchy, dry skin.

• Allergic reaction from birth control liquid or gel.

• Psoriasis - skin cell buildup causes dry, itchy scales.

• Lichen planus presents as purple, itchy flat bumps due to swelling and irritation.

• Seborrheic dermatitis - causes an itchy rash with flaky skin.

• Zoon's balanitis - usually presents as solitary, erythematous plaque on the penis glans.

• Balanitis - There are more chances of getting balanitis in males with tight foreskins and diabetes mellitus.

• Pearly penile papules are dome-shaped bumps on the penis head.

3. Precancerous and Cancerous Conditions: Local (in situ) skin cancer on the penis may be present, which includes;

• Erythroplasia of Queyrat (a form of squamous cell carcinoma) is characterized by well-defined reddish, velvety pigmentation of some areas of the penile skin.

• Bowen disease of the penis - whitish-gray thickened areas on the shaft of the penis, seen mostly in uncircumcised males.

• Bowenoid papulosis - small and often multiple bumps are present on the shaft of the penis.

• Adenocarcinoma - a form of carcinoma developing on the glands lining the organ.

• Penile intraepithelial neoplasia - a rare pre-malignant disease of the outer skin layer (epidermis) of the penis.

• Precancerous conditions such as candidiasis- a fungal infection caused by candida yeast.

• Squamous cell carcinoma (SCC) -a malignant tumor which is the most serious condition.

How to Diagnose Penis Skin Problems?

It is challenging and essential to diagnose penile skin conditions as the cause can range from remediable rash to cancerous involvement. Doctors' evaluation is required in case of persistent and painful debilitating conditions. A sexologist can help diagnose through careful clinical examination and history taking. Doctors may suggest some tests to detect yeast infections or STDs; blood sugar level tests to detect diabetes mellitus in case of recurrent infections.

How to Avoid Penile Skin Conditions?

Some measures one can take to keep penis skin healthy such as,

• Maintaining good hygiene, especially under the foreskin.

• Proper vaccinations such as the HPV (human papilloma virus) vaccine.

• Avoid harsh soap and use mild, hypoallergenic products.

• Adopting a healthy lifestyle, such as limiting smoking and alcohol consumption

• Protection using barrier methods before sex to avoid STDs.

• Sometimes, having circumcision if the skin is too tight around the glans may help reduce infections. A procedure to remove the foreskin of the penis is called circumcision.

What Are the Treatment Modalities for Penile Dermatological Conditions?

With many causative factors for penile skin conditions, treatments, and management are also underlying cause centric.

• For peeling of penile skin, the first line of therapy is using mild Corticosteroid creams in case of friction, psoriasis, and eczema.

• Rash due to latex allergy, polyurethane condoms are a good alternative.

• Antifungal creams like clotrimazole are effective on the thrush of yeast infection on penile skin.

• The recurrence rate is high in the case of warts. A new topical immunotherapeutic agent - imiquimod - is recommended, including interferon and other cytokines.

• Scabies and pediculosis are transmitted through skin-to-skin contact, so proper hygiene measures such as frequently washing hands before coming in contact or touching skin may help.

• The physician may prescribe a medication used to treat infection caused by parasites, like oral Ivermectin, after a specific test for scabies infection.

• In case of allergic contact dermatitis of the penile skin, removing and avoiding irritants such as lubricants, feminine hygiene products, deodorant sprays, latex condoms, and spermicides is helpful.

• Wearing clean and dry underwear clothing is helpful in case of rashes due to persistent moisture and maceration.

• If STD is the cause of the skin problem, the sexologist will treat it with antibiotics depending on the type and severity of the infection.

• SCC of the penis is the most common penile malignancy, requiring biopsy for diagnosis. It may require surgical intervention. Early detection of precancerous lesions, identification of risk factors, and proper treatment of phimosis (inability to retract the foreskin behind the tip of the penis) is essential to prevent SCC of the penis.

• Painful paraphimosis can be treated with local anesthetic cream, ice packs, or oral painkiller medications.

• Pearly penile papules are treated at home care through the over-the-counter antibiotic cream application. In severe cases, pulsed dye laser treatment is the most effective.

What Is the Prognosis of Penile Dermatological Conditions?

Apart from the malignant conditions, penile skin problems have a good prognosis. Inflammations and symptoms are reducible by applying prescribed medicated creams.

What Are the Complications of Penile Skin Conditions?

If left untreated penile skin infection becomes severe with a subsequent increase in symptoms. Untreated precancerous lesions may become malignant. Pain related to these conditions impairs sexual functions.

Conclusions:

Penile dermatological conditions can adversely interfere with a person's daily life and may affect interpersonal relationships with partners and self-esteem. Sexually active persons should undergo regular screening for optimal penile health, as many infections may exhibit symptoms in the early stages. A person should seek medical attention if the above signs or symptoms are seen and experienced.