Dr. Dhepe Snehal Madhav
Venereology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I am having a rash or irritation on the head of the penis for six months and have tried multiple creams. Even after trying a Fluconazole steroid cream referred by a dermatologist, I cannot get rid of it. I believe the Fluconazole cream helped but did not eliminate the problem. This dermatologist said he thought I had balanitis, so he gave me Pimecrolimus cream to apply and said I would not need a follow-up appointment. After a month of use, the cream seemed to reduce redness but has not helped eliminate the problem, and the redness and bumps are back after a few days. Now, I have to wait six months before his next available appointment. At the start, it also caused foreskin tightening and thickening of the skin, which has now stopped and not been a problem. Also, the rash does not cause any pain, smell, or discomfort. I am using Elidel (Pimecrolimus) cream twice daily now. Earlier, I was using high strength Hydrocortisone cream, and capsule Fluconazole 150 mg weekly for six weeks. Diabetes levels were checked and came back negative. Please advise.
Hello,
Welcome to icliniq.com.
I suggest the use of Clotrimazole cream twice daily for three weeks. I will also want to know if you are sexually active? Have you had unprotected sex in the last three months? Have you had any exposure to STDs (sexually transmitted diseases)? Any allergy or irritation to the use of Steroids? And for how long did you use the cream? Thank you.
Patient's Query
Hello doctor,
Thank you for the response. I have not been sexually active for about two months. I am worried it may irritate it and cause a longer-lasting problem; however, the doctor was not concerned about any STDs, and I had only had chlamydia about four years ago. I have used it twice daily for a month now. I used the first cream for a month, the second I used for six weeks as prescribed. It does not seem to irritate; however, now I am worried the skin may be damaged as some days it looks like the top layer of skin is loose and wrinkly instead of a normal smooth texture, as shown below. Is it okay to still use Elidel cream? Please advise.
Hello,
Welcome back to icliniq.com.
I understand your concern. As per the photos attached (attachment removed to protect the patient's identity), it is Balanitis. It is essential to have good hygiene, keep the affected area dry, and medication is important. I would suggest you to use antifungal creams like Clotrimazole cream and tablet Zifi 200 (Cefixime and Ofloxacin). Follow-up would be necessary. I hope this helps. Thank you.
Patient's Query
Thank you doctor,
Will I need a prescription for any of these products? Also, do I use them all at the same time? I have been using a fragrance-free soap that is supposed to be gentle called DermaVeen and making sure to dry after showering or urinating for a few months, which does not seem to change anything. Please advise.
Hello,
Welcome to icliniq.com.
I suggest you use OTC cleanser (over-the-counter), whichever suits you. The gentle cleanser mentioned above is a good option. The cause needs to be ruled out as it is recurrent, so get a urine routine or culture or Microscopy done. Please make sure you take good care of the area and keep it dry. Apply the creams, and eventually, your discomfort will reduce. I hope this helps. Follow up after four weeks. Thank you.
Patient's Query
Hello doctor,
Thank you. I have used Clotrimazole for three weeks, and it seemed to reduce redness while I was using it possibly; however, after I have stopped using it for a week now, I still have redness in the majority of the area. I also received a swab test that showed no yeast or bacteria. I could not find any Zifi 200 tablets in my country. Please advise.
Hello,
Welcome back to icliniq.com.
Hygiene plays a significant role in recurrent balanitis. Therefore do the following. Maintain proper genital hygiene. Keep the area clean and dry. Avoid keeping the area wet. Avoid moisture, heat, injury, occlusion, friction at the site. Maintain sugar levels under control. Avoid scratching and rubbing of lesions. Wear loose, comfortable thin cotton inners. Wash area with Episoft cleanser or No soap cleanser daily. Also, I suggest you continue Clotrimazole (Imidazole derivatives with broad-spectrum, antifungal activity) cream twice daily for seven days, Fucidin (Butylhydroxyanisole, Cetyl alcohol, and Potassium sorbate) cream once a day for seven days. Take Tablet Fluconazole 150 mg once a day after food for three days. I hope this helps. Thank you.
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Venereology
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