Dr. Rabia Anjum
Dermatology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
Answered by
Medically reviewed by
Patient's Query
Hello doctor,
I have a severe infection on my penis head which I suspect (also confirmed by a doctor) to be Zoons balanitis. The infection has been for a year now. I am circumcised and this infection has been recurring for the past six years in the same area. The infection has eaten off the whole skin on my penis head and also blocked my urinary opening. It is so painful and burns when I pee.
I have been applying a Fucibet cream for seven days now and also taking antibiotics prescribed by a Dermatologist but no improvement. I do not know what to do. I have been to various doctors including Urologists. They have done a biopsy and the results came back negative on cancer cells. I have tested positive for herpes and MRSA. Please help.
Hello,
Welcome to icliniq.com.
Can you send a picture of your lesion for proper diagnosis and treatment? Please avoid application of steroids over the area. It is good that you are circumcised.
Patient's Query
Hi doctor,
I have attached the pictures.
Thank you.
Hi,
Welcome back to icliniq.com.
Clinically, it seems like lichen sclerosus et atrophicus (attachment removed to protect patient identity). What was your exact diagnosis on skin biopsy? It is severely infected at this moment. Kindly stop applying potent Steroids in this area until the infection gets clear. Take a pure Antibacterial tablet and apply Antifungal cream. Most importantly maintain hygiene of the area.
Here is the prescription. Tablet Linezolid 600 mg BD for two weeks, tablet Aciclovir 400 mg BD for three weeks, apply Fusidic acid plus Isoconazole combination without Steroids. Wash the area with mild soap and water. Avoid using Dettol and other irritants. Once your infection is cleared, do a skin biopsy from a good center to rule out LSA. I have given you medication to eradicate MRSA and herpes infection. Again a reminder: Do not apply Steroids. Follow up at two weeks. Get well soon.
Thank you.
Patient's Query
Hi doctor,
I have taken Linezolid for more than 12 days two months back and Acyclovir repeatedly in the last six months. The infection did not clear. For seven days now I have been applying a Fucibet cream and also taking the following antibiotics: BE tablet Prednisone 5, Clindahexal 150 mg, Lovire (Acyclovir) 200 mg. I only clean area with saline solution or just warm water.
Thank you.
Hi,
Welcome back to icliniq.com.
You see 12 days is not enough for Linezolid. You have to take it longer. Also, Acyclovir has to be taken for a longer period of time. And steroids should be avoided in case of active infection. Steroids themselves precipitate infections. You have to take an Antibiotic and Antiviral for longer duration without steroids. It is good that you use saline water. Regards.
Patient's Query
Hi doctor,
As you said no Steroids and it seems the Fucibet cream that I have been using has Steroids in it as so is Prednisone. I will stop both right away. Can I apply the Mupirocin ointment (Nuban) while I wait to get the Doctor's prescription for Fusidic Acid cream as it needs a prescription?
Thank you.
Hi,
Welcome back to icliniq.com.
Yes, Fusidic Acid ointment needs prescription. Yes, you can use Mupirocin ointment for short duration. Get well soon.
Patient's Query
Hi doctor,
This is my follow-up since my consultation with you. The infection has not cleared, or the discharge stopped. I have been applying Fucidin ointment since then twice a day. No improvement.
Thank you.
Hello,
Welcome back to icliniq.com.
Thank you.
Patient's Query
Hi doctor,
I have attached the biopsy file that was done. Two experts have gone through it twice through the biopsy and discovered no trace of cancer cells or similar. I have been consulting with a Dermatologist who also recommended that I continue applying fucidin ointment and lately also prescribed a Dovate cream to apply together with fucidin.
Thank you.
Hello,
Welcome back to icliniq.com.
The doctor has prescribed you the right treatment. I have added antifungal (anticandidal) capsules. I hope it will improve your discharge problem.
Thank you.
Patient's Query
Hi doctor,
Please note that there is no improvement after 13 days of applying the Fucidin cream, Dovate cream, and Cloxacillin 500 mg. The discharge continues to flow, and the yellowish cheesy discharge covers the penis. The infection also seems to be growing further. The dermatologist told me today to return to the urologist for surgical cleaning of the infection. I feel I am now between a hard place and a rock. It is now over a year with this infection. I have already been to more than two urologists.
Thank you.
Hello,
Welcome back to icliniq.com.
Please take antifungal treatment along with this treatment.
Kindly take capsule Fluconazole 150 mg. Also, take a fresh culture of discharge to look for the specific organism causing it.
I know it is a very distressing condition for you. Improve your diet with proteins so that it can boost your immunity. But do these two things
1. Take antifungals.
2. Do a culture sensitivity test of discharge.
Thank you.
Patient's Query
Hi doctor,
I have been taking Fluconazole as per your prescription. Should I increase the dose for a severe infection like mine to stop the discharge? I have noted an increase in discharge (excessive fluid discharge). What is the meaning of excessive discharge?
Thank you.
Hello,
Welcome back to icliniq.com.
Excessive discharge means the quantity of discharge (pus and fluid) coming out is more (like if grading is done according to severity, less, or more). If you have more severe discharge, you can take Fluconazole 150 mg on alternate days instead of the weekly dosage.
Thank you.
Patient's Query
Hi doctor,
What I am saying is there is excessive fluid discharge from the infection. I want to know if it is good or bad for the clearance and healing of the infection and what is causing it. I was expecting the infection to start to dry up when I started taking Fluconazole.
Thank you.
Hello,
Welcome back to icliniq.com.
No increase in discharge is not a good sign. It does not show healing. It rather shows a double infection, like a superadded bacterial infection. That is why I asked you to have a culture sensitivity test of discharge a few days back to assess antibiotic sensitivity.
Also, in addition to that, increase the dose of Fluconazole on alternate days.
Thank you.
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Dermatology
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