What is the treatment for painless red spots on my penis?

Question

Hello doctor,

I am a 24-year-old male. I have red spots on the penis. They are not itchy, and there is no discharge. I do not feel any discomfort or pain during urination. I visited a clinic and was prescribed Fluconazole along with Clotrimazole for two weeks, but there was no improvement. I returned to the clinic and was given Clotrimazole alone. It has now been two weeks, and there is still no change.

Recently, I have noticed a reduction in penis size. I am unsure whether this is related to the medications or another cause. Before this, around two months ago, I noticed one or two small spots. After having sexual intercourse at that time, the spots increased in number about one week later. I humbly request guidance and treatment options that could help with these painless red spots, as they are causing significant concern.

Kindly advise.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

On visual assessment (attachment removed to protect the patient’s identity), the lesion appears as multiple small, flat-topped, faintly erythematous to skin-colored papules on the penile skin. There is no surface scaling, erosion, ulceration, vesiculation, or discharge.

The skin texture appears slightly thickened with accentuated skin markings rather than being inflamed. This morphology, along with the absence of pruritus, pain, dysuria, or response to antifungal therapy, strongly suggests a non-fungal, non-infective inflammatory or benign condition.

We need to rule out lichen nitidus, which classically presents as multiple tiny, shiny, asymptomatic papules on the genitalia of young adults; early lichen planus; or frictional or irritant balanitis.

Candidiasis is very unlikely due to the absence of erythema with maceration, discharge, itching, and the complete lack of response to adequate antifungal treatment. The appearance is also not typical of human papillomavirus (HPV) warts, molluscum contagiosum, herpes simplex infection, or syphilis, all of which have distinct clinical features that are not present in this case.

The perceived penile shrinkage is not caused by Fluconazole or Clotrimazole. It is most commonly related to anxiety, sympathetic vasoconstriction, cold exposure, or psychological stress rather than a true structural change. There is no evidence of scarring, atrophy, or tissue loss on visual assessment.

From a dermatological standpoint, further use of antifungal medications should be discontinued to prevent irritant contact dermatitis. Management usually includes gentle genital skin care, avoidance of friction, harsh soaps, and antiseptics.

After in-person clinical confirmation, short-term use of low-potency topical corticosteroids or topical calcineurin inhibitors, such as Tacrolimus, may be considered if an inflammatory dermatosis such as lichen nitidus is confirmed.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.