Why did the itching and redness on the head of my penis not go with the prescribed medicines?

Hello,

Welcome to icliniq.com.

Thank you for your query.

As mentioned earlier, Miconazole (antifungal) gel may take months to show changes since candida balanitis lesions take months to heal. However, I would like to change the medications to stronger dosage since you have not noticed any significant changes.

As per your history and image, it is balanitis, as you have mentioned (attachment removed to protect the patient's identify). Still, balanitis is due to multiple reasons and one of which is candida, and this is candida balanitis. Balanitis is an inflammatory condition on the glans penis and under the foreskin due to multiple cause. It is often accompanied by skin sensitivity. It can result from trauma, using harsh soap or chemicals, excess cleaning of the area, fungal and bacterial infections, and allergic reactions. They present as scaly white dry lesions with few inflamed areas, which may be itchy, sometimes painful, and produce a burning sensation while urinating. They may appear on and off and differ in severity from person to person. But they are not life-threatening. I suggest you to follow a few instructions mentioned below.

1. Apply Tacrolimus (topical calcineurin inhibitors) 0.03 % ointment on the affected spot in a thin layer at night every two days, initially for two weeks. Then apply it on alternate days for two weeks and later daily at night for two weeks. After that, you can stop using the ointment. Do not use excess amounts, as they may cause mild irritation and a burning sensation. The lesions would take time to subside, even up to months, and may vary among individuals based on their severity.
2. Avoid using harsh soaps or chemical washes to clean the area. Use lukewarm salt water.
3. Apply Hydrocortisone cream (topical corticosteroid) 1 % in a thin layer once daily in the morning for four weeks on the affected area to keep the area less inflamed, along with Miconazole gel for six weeks.
4. Apply Novasoft (emollient) and Fusidic acid (antibacterial) cream in the afternoon on the lesion daily for six weeks in a generous amount to keep the area hydrated and free from secondary infection. The Novasoft cream may also be mixed in the morning with Hydrocortisone and Miconazole gel to reduce the irritation.
5. Laser therapy may also help, which is not invasive but will provide better results. In addition, carbon dioxide Laser treatment helps eliminate the lesion's severity and inflammation.
6. Take tablet Limcee (vitamin C) 500 mg chewable tablet twice daily after food for one month.
7. Take tablet Cetirizine (antihistamine) 10 mg at night for one week. Avoid going out or driving after consuming the tablet as they are sedative.
8. In case of any penile secretion, ensure a swab test is done from a laboratory to ensure they are not infected. In addition, they would help with ruling out the presence of fungal and bacterial infections, in which case antifungals and antibiotics in oral form may be required.
9. Take capsule Omega-3 (nurtitional supplement) once daily in the morning after breakfast for two months. They help in keeping the area moisturized.
10. Consume at least 14 cups of water daily.

Kindly consult a specialist, talk to them and take medications with their consent.

I hope this has helped you. Thank you.