How to treat long-standing irritation of the glans penis?

Hello doctor,

For the past 18 months, I have been dealing with irritation on the glans of my penis. The skin appears red, dry, and more irritated than usual, as if the natural mucus membrane and oils are not functioning properly. Upon close examination, I have noticed diffuse redness, some cracks, erosions, and tiny raised red spots. I have tried various treatments over the past 18 months for the persistent glans irritation on my penis. I attempted Clotrimazole cream for two weeks, but it worsened the irritation. Clindamycin cream, applied for the same duration, showed no improvement. Protopic (Tacrolimus one percent) had a negative impact when used for a week. Fucidin cream and Fucibet (a combination of Fucidin and Betamethasone) did not affect the condition. Topical Metronidazole gel aggravated it further. Even a week of oral Azithromycin and Metronidazole did not produce any positive changes. Topical Hydrocortisone did not help, nor did washing with water (no soaps or shower gels). I tried cleansing with various solutions, including salt water, one percent saline, and five percent saline, as well as a 2.5 percent acetic acid cleanse (vinegar and water mix) twice a day, but none of this provided relief. I also changed to different underwear, always using 100 percent cotton, but this adjustment did not make any difference in the irritation. Emollients like double base cream and vaseline did not help.

This problem occurred suddenly while I was in a remote area with no human contact. I usually maintain good hygiene, showering at least once a day. I am unsure if this issue is related to balanitis, dermatitis or eczema, or something else. It is becoming increasingly frustrating and has led to cracks and erosions. I apologize for the image quality; I plan to acquire a better camera to assist with diagnosis. I also tried topical Acyclovir, but it did not provide relief. I have attempted the above treatments at various times over the last 18 months. Please help.

Thank you.

Hi doctor,

Thank you for your reply.

I apologize for not mentioning some of the treatments I have tried earlier. I did use Mupirocin cream for two weeks and underwent a three-week course of oral Fluconazole (150 mg per week) a few months ago. However, I have not yet attempted topical Ketoconazole or Nystatin, and I will certainly try Ketoconazole as per your recommendation. I also tried topical Clobetasol propionate (known as dermacort here), but it did not provide any relief. About two months ago, I had blood tests done for another issue, and they indicated that my HbA1c was within the normal range, suggesting that I do not have diabetes. Additionally, my complete blood count parameters and thyroid function were normal, although my cholesterol levels were slightly elevated, measuring around approximately 215 in US units. I would like to clarify that the skin issue is not related to any recent relationships, as I have not been in a relationship for quite some time. The condition is causing me significant stress and frustration, as it tends to flare up with any form of friction, such as rubbing against clothing or activities like cycling. Even if I miss my morning or evening showers, it can exacerbate the problem. I am also dealing with other health issues, which only adds to the overall burden. I appreciate your suggestions regarding Ketoconazole, and I will give it a try. Also, I was on a two-week course of Prednisolone at 60 mg with taper for an ear issue, but it did not have any positive effect on the skin issue and I took Doxycycline for an infection at one point, which did not help either. Last year, I was prescribed Augmentin (Amoxicillin and Clavulanic acid) for a suspected ear infection, but it had no impact on the skin issue. I have come across information about other oral antibiotics sometimes used for skin issues, such as Flucloxacillin and Erythromycin. I wonder if these could be worth considering. However, if you have any further suggestions based on the provided information, please let me know. Furthermore, I am unsure if you have expertise in another area, specifically scar revision. If you do, please inform me, as I would appreciate some advice regarding surgical scar revision on my hand and leg.

Thank you.