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Q. I have red rashes encircled with white patches on the glans and foreskin. What could it be?

Answered by
Dr. Snehal Laul
and medically reviewed by Dr. Preetha J
This is a premium question & answer published on Oct 18, 2020

Hi doctor,

I am 63 years old and I am diabetic. I felt allergy last week on the second day of starting Febuxostat, which was given to mitigate calculi in the left kidney. There are red rashes encircled with white patches seen on the back of the head of the glans and foreskin, and there is no relief for the past one week. I previously suffered from candidiasis and used medicines like Fluconazole and Clotrimazole oinment. I currently take Metformin 500, Glimepiride 2 mg (BD), Telma 80x1, Clopidogrel 75 one tablet at noon and Pregacip M. My TGL and Cholesterol levels were higher than normal. So I was prescribed Statins, which were allergic and triggered hay fever on the second or the third day. I tried many but remained allergic. So I had stopped statins and reduced fatty food consumption and maintained TGL and cholesterols at border levels.

Dr. Snehal Laul

Dermatology Venereology
#

Hi,

Welcome to icliniq.com.

You can try,

1. Fucidin (Fusidic acid) cream twice daily for seven days (in the morning and noon).

2. Candid B (Clotrimazole and Beclomethasone) cream at night for ten days.

The lesion will take time to heal in diabetic patients.

  • Do you have any history of fever?
  • Do you have any history of Tinea (a fungal infection on skin-other body areas)?
  • Do you have any history of recurrent candidal balanoposthitis?
  • Do you have any painful lesions?
  • Do you have burning micturition?
  • Do you experience an increased frequency of urination?
  • Do you use harsh soaps?
  • Do you have any itching?
  • Did you scratch or rub the lesion?
  • Do you follow improper penile hygiene?
  • Do you have any history of atopy or allergies?
  • Do you have any history of a drug allergy?
  • Do you have any history of fixed drug eruption?

Answer the questions for details.


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Hi doctor,

Thank you for your reply.

I have no history of fever, tinea, or recurrent candidal balanoposthitis. The lesion is not painful. There is no burning during micturition and no increase in the frequency of urination. I always use a half drop of Nizoral or Selsun shampoo in running water. I have mild itching. I do not scratch or rub the lesion, and are maintaining excellent penile hygiene. I have mild allergic rhinitis, triggered by Statins, and no history of fixed drug eruption.

Dr. Snehal Laul

Dermatology Venereology
#

Hi,

Welcome back to icliniq.com.

  • Use mild cleansers like without soap, Episoft cleanser, Cetaphil cleanser to wash the genital area.
  • Avoid using harsh soaps or shampoo on genitals.
  • Avoid scented soap and lotion used on the genitals.
  • Always clean the glans penis after retracting the foreskin.
  • Wash with lukewarm water.
  • A neutral non-soap cleanser, as mentioned above, can be used.
  • Dry the area after cleaning.
    1. Do you have any history of herpes genitalis?
    2. Are there any fluid-filled blisters or any erosions?
    3. Do you have any swelling or inflammation of the penis?
    4. Do you have a tight foreskin?
    5. Do you have any history of injury or microtrauma?

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Thank you, doctor, for your reply.

I do not have any tingling sensation or any history of herpes genitalis. There are no fluid-filled blisters or erosions present. I had an injury with a water jet, and there, a mild spot of blood came out. I do not have any swelling or inflammation of the penis and do not have a tight foreskin.

Dr. Snehal Laul

Dermatology Venereology
#

Hello,

Welcome back to icliniq.com.

You can try,

  • Fucidin (Fusidic acid) cream twice daily for seven days.
  • Candid B (Clotrimazole and Beclomethasone) cream at night only once for seven days.
  • Tablet Emanzen D (Diclofenac and Serratiopeptidase) and twice daily for three days (if there is pain or tingling).
  • Tablet Zifi (Cefixime and Clavulanic acid) 200 mg twice daily for five days.

Systemic antifungal are usually not given if there is liver or renal issues. Avoid touching lesions, as it may cause secondary bacterial infection. Do all STI (Sexually transmitted infection) panel tests. Genital herpes, HIV (human immunodeficiency viruses), HCV (hepatitis C virus), VDRL (venereal disease research laboratory), chlamydia, and gonorrhea. To rule out STI infection, also do urine culture, urine routine, or microscopy. Maintain sugar levels in the normal range. It is a candidal balanoposthitis. It is a common fungal infection in diabetes. Lesion takes time to heal as there is slow healing in diabetes. Get all lab investigations done and follow-up after seven days. Take care. Get well soon. Regards.


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1. The tingling/itching and lesions almost completely disappeared from Glans.
2. A couple of hard dark pinkish lesions(right side) and darkened skin(left side) on retracted prepuce frenulums are present with occasional tingling.
3. A couple of boils like lesions erupted and remained on scalp of head since beginning(if any significance)
4. Blood and Urine test results are awaited as samples were sent outstation. Please do confirm if I have to report to you any negative results.
5. As prescribed, Zifi 200 only taken BD for 5 days and stopped. Ointments applied as prescribed till date. No abnormalities like fever, headache nausea etc. BS levels monitored regularly and maintained normal.

Dr. Snehal Laul

Dermatology Venereology
# Miconazole gel /candid cream twice daily for 5 days(on pink patches)and Fucidin cream once on pink lesions .

Fucidin cream and Candid cream each once on black lesions for 5 days.

Stop Antibiotic zifi.

Use cleanser Episoft or no soap to clean genitals.
Maintaining hygiene is very important in this case.

Lot of improvement is seen.

Revert back with reports.

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Recommended lab reports arrived. Attached for your review.

Dr. Snehal Laul

Dermatology Venereology
# There is UTI (Urinary tract infection),e.coli infection.
( as mentioned in urine culture reports)

STI panel tests as negative.

Tab Nitrofurantoin 100 mg at night after food for 3 days.

Cital syrup 3ml twice daily for 7 days.

Drink lots of water.
stay hydrated.

Urinate frequently.

Avoid spicy foods,fatty foods,ice cubed beverages,
coffee.

Before starting Nitrofurantoin tablet ,need to ask few questions,
any kidney issues?
Anemia,vitamin deficiency?
blood disorder?
Drug allergies?

Bloody diarrhea?
vomiting?

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