Dr. Dhepe Snehal Madhav
Venereology
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Patient's Query
Hi doctor,
I am diabetic and hypertensive. I am under the following medication. Take Tablet Glimepiride 3 mg, Tablet Metformin 1 mg twice daily, Tablet Telmisartan 40 mg, Tablet Ecospirin 75 mg, Tablet Sitagliptin and Tablet Urimax 0.4 mg. Blood sugar readings are now in control (random blood sugar level - 111 mg/dL), but for the last few days, fasting blood sugar level is 150 mg/dL and PP around 220 mg/dL. I initially developed redness on my glans and tightness of foreskin while retracting. The tip of my foreskin has been swollen and cannot be retracted back. I had consulted a doctor, and he advised me tablet Augmentin 625 mg twice daily, Candid Ointment, and Neosporin ointment thrice daily for five days. But even after five days, there is no relief from the swelling, and the foreskin is still not retractable. What medicine should I take to subside the swelling?
Hello,
Welcome to icliniq.com.
I can understand your concern, and I would like to know the following details so that I can guide you better. Do you have a burning sensation during urination? Do you have urethral discharge and pain? Do you have recurrent balanitis? Do you practice improper genital hygiene? Do you have experience excessive scratching and rubbing?
Patient's Query
Hi doctor,
I have had a slight burning sensation during urination, no urethral discharge as of now, little discomfort when I touch the tip, and recurrent balanitis for the last few weeks. I have itchiness not on the affected area but the sides of my groin. There is no improvement with the tablet Augmentin 625 mg and ointments Candid and Neosporin. Kindly help.
Hello,
Welcome back to icliniq.com.
It is balanoposthitis (swelling of the glans penis and prepuce or foreskin). It could be due to poor or improper hygiene, tight foreskin, uncircumcision, scratching or rubbing, allergic reaction to irritant soap, infection (fungal or bacterial or viral), other causes like uncontrolled diabetes, balanitis xerotica obliterans (inflammatory skin disease), eczema, exposure to chemicals. The possible symptoms are irritation, tenderness, pain, dry foreskin, foul-smelling discharge, and burning. Do you have liver or renal issues? Are you sexually active? I would suggest you avoid scented soaps and lotions. Always clean the glans penis after retracting the foreskin. Wash with warm water. Use a neutral non-soap cleanser like Episoft cleanser, No soap cleanser, or Cetaphil cleanser to clean genitals. Dry the area after cleaning. Always wash the private area after sexual activity. Keep a check on sugar levels. Do urine routine or urine culture or microscopy test. A swab test can be done to check for possible infection. Practice good hygiene as hygiene plays a significant role. The cause should be found and treated to avoid recurrent balanitis. I would suggest the following medicines. Take Syrup Cital (disodium hydrogen citrate) 3ml twice daily for seven days. Apply Fucidin (Fusidic acid) cream in the daytime for ten days. Apply Miconazole cream (Micogel) in the evening or night for two weeks (on itchy groin site or area of swelling, redness, and inflammation). Use an Episoft cleanser to clean genitals. Avoid occlusion or friction, or injury. Avoid scratching and rubbing of lesions. Avoid moisture or heat as moisture favors fungal growth. Wear loose, comfortable thin cotton inners. Stay in a well-ventilated room or cool environment. Avoid activities that cause sweating. Regards.
Patient's Query
Hi doctor,
I have no liver and renal issues. I am quite sexually active but only with my wife. I am unable to have sex due to swelling and tight foreskin. I will start the medication immediately and revert after a week.
Hello,
Welcome back to icliniq.com.
Yes. Do follow up after a week. Regards.
Patient's Query
Hello doctor,
A week has passed since you advised medication for my recurrent phimosis or balanoposthitis. I took Cital syrup 3 ml as recommended in the morning and night, Fucidin cream during the daytime, and Micogel at night. I have a minimal improvement in the phimosis problem, but definitely, there is lesser inflammation and swelling at the foreskin tip. The foreskin is still not retractable properly. I have attached photos. I have had a new issue cropped up in the last three days. The sides of my groin area look cracking, flaky, itchy, and turned red or sore. My blood sugar reading is 140 to 150 mmHg during fasting and PP around 180 to 190 mmHg. What do you advise? Do I need any change in medication or continue with the same medications. Also, let me know if I can try the phimosis silicon ring kit to stretch my foreskin. Is circumcision avoidable? If circumcision is needed, which is the best method, ZSR kit or laser or conventional?
Hi,
Welcome back to icliniq.com.
Sugar levels are too high. Maintain sugar levels under control. Candidal Balanoposthitis is caused by candida Albicans, which is a fungus. It is common in men and diabetics. White and lumpy discharge is seen under the foreskin, and inability to pull the foreskin back, swelling, irritation, soreness, itching are associated symptoms. Risk factors are uncircumcised penis, uncontrolled sugar levels, poor hygiene, obesity, dry skin, eczema, scented soaps/moisturizer, lubricant can irritate skin, poor diet, not drying the private areas properly after washing them. It is not transmitted through sexual activity, but advisable to refrain from unprotected sex until the infection is treated. Continue Miconazole gel twice daily for seven more days. Take tablet Fluconazole 150 mg once a day after dinner for seven days. Use Mupirocin ointment at daytime for 15 days(on fissured skin /groin lesions). Treatment with antifungals shows a cure rate of 95 percent. Maintaining good personal hygiene helps prevent and treat this condition. The penis head should be washed carefully with warm water after retracting the foreskin. Avoid using scented or hard soaps on genitals. Pat dry the penis and glans penis with a soft towel after retracting the foreskin. Wear loose underpants to keep your genitals cool and dry. Visit the surgeon for advice on circumcision, get examined by him, then he will decide which procedure will suit you. Infection recurs if blood sugar levels are not controlled. When urine containing sugar dribbles and stays on the glans penis, and foreskin, it becomes a friendly place for yeast and bacteria to feed and grow, resulting in infection. Regards.
Patient's Query
Hello doctor,
Thanks for your suggestion. Sugar levels are slightly down than before, but there is improvement in the foreskin condition. It is a little tight to pull back foreskin but able to do so for cleaning the glans. However, swelling on the foreskin tip has reduced after taking your prescribed medications. I am continuing tablet Fluconazole, Micogel, and Mupirocin ointments for seven days. There is improvement in groin area lesions and fissured skin, and the infection subsides. I want to show you a few attached reports for further advice on continuing this medication.
Hi,
Welcome back to icliniq.com.
Improvement is seen after an excellent follow-up of the treatment plan. Reports show three-plus sugar levels in urine, which is the possible cause. Maintain the blood sugar levels. Repeated attacks of infection cause phimosis. It permits the accumulation of urine or secretion or residues, which favors secondary infection. So, continue the above-mentioned treatment for seven days. Treating infection will relieve phimosis issues to some extent. Regards.
Patient's Query
Hello doctor,
After taking the medication for the last three weeks, I am almost relieved from my previous ailment of balanitis and phimosis. Now, I have a new problem which is severe dandruff and flaking because of this, I have shaved my head and found that I have red-brown itchy patches on my scalp. Photos are attached. I have applied pure virgin coconut oil but the patches are looking aggressive even now, so I require some medical advice from you. I am considering the last medicine given by you for antifungal problems in my groin and infection on my foreskin and glans penis. Kindly suggest the medication.
Hi,
Welcome back to icliniq.com.
It is tinea capitis (due to a superficial fungal infection). Apply Luliconazole 1 percent lotion or Luliact cream twice daily in the morning and night for three weeks on scalp lesions. Wash the area with Ketoscalp shampoo (Ketoconazole and Zinc pyrithione) on alternate days for ten days, and then thrice weekly for six weeks. Apply Candid cream (Clotrimazole cream) at night on penile inflammatory lesions for seven days. Avoid scratching and rubbing of lesions. Maintain proper hygiene. Take the tablet Teczine-M (Levocetirizine and Montelukast) once at night after food for seven days if you have itching. Use Dersil AF body wash (Ketoconazole) or KZ soap (Ketoconazole) for bathing for a month. Regards.
Patient's Query
Hello doctor,
I have been taking the advised medicines for the last twelve days, but there is little relief on my scalp lesions. Also, the swelling on my penis foreskin has subsided, and I can retract it in the flaccid state. However, when I erect, it is difficult to retract the foreskin. Pictures are attached for your perusal. Are both fungal infections related to each other? I am taking the tablet Pantop and the capsule Itraconazole 100 mg twice daily for a month as advised by a dermatologist for the fungal infection of my penis and groin area. You are requested to evaluate and recommend further medical treatment as there has been partial relief for both the problems, for the last few weeks. Thanks and regards.
Hello,
Welcome back to icliniq.com.
You can continue with the following medication. Apply Micogel cream (Miconazole) in the evening and night for three weeks. Apply Mupirocin ointment in the daytime for fifteen days. Also, please avoid scratching and rubbing the lesions. Keep a check on your sugar levels. I also want to know whether you have used Luliconazole cream or Clotrimazole cream? Is there any itching at present? Kindly share the details so that I can guide you better.
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Venereology
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