The skin on the male genitalia is a common site for skin problems but there is often delay seeking help because of embarrassment or not knowing where to get the best advice. Skin conditions on genital skin can be part of a general skin condition affecting skin elsewhere on the body (e.g. psoriasis and eczema) or be specific to genital skin (e.g. lichen sclerosus).
Inflammation of the skin on the penis and foreskin is known as balanoposthitis. This can be asymptomatic or may be associated with itching, pain, tightness of the foreskin and sexual dysfunction. The cause of a balanoposthitis is wide-ranging and can be broadly divided into inflammatory, infectious and precancerous and includes conditions such as lichen sclerosus, lichen planus, Zoon’s balanitis, psoriasis, seborrhoeic dermatitis and eczema (atopic, irritant or allergic contact), candidiasis and penile intraepithelial neoplasia (pre-cancers). Lumps and bumps on the penis can be caused by infections such as viral warts, molluscum contagiosum, herpes or scabies.
Lichen sclerosus is a chronic inflammatory skin condition that specifically affects genital skin. It can present with a red rash, white patches, tightness and difficulty retracting the foreskin. Symptoms include itching, soreness, discomfort on erection and pain on sexual intercourse. It tends to only occur in uncircumcised men and is often associated with dribbling of urine. The cause of lichen sclerosus is not known but thought to be due to irritation from urine trapped between the penis and foreskin in a susceptible person. It is usually diagnosed through clinical assessement and only occasionally is a skin biopsy required for confirmation of the diagnosis or to exclude other pathology. Treatment involves the use of soap substitutes, barrier creams and topical corticosteroids. Many patients respond well and can go into remission. Some have to manage occasional flares with topical corticosteroids. Those with recalcitrant/unresponsive lichen sclerosus may benefit from circumcision.
Lichen planus is a condition affecting the skin and mucosal sites, including the genital skin, which causes chronic inflammation. This presents with small papules (bumps) on the top of the penis which may develop into a ring. Another variant is of an erosion of the top of the penis. Diagnosis can be made clinically, although sometimes a small biopsy may be needed. Treatment is aimed at treating the underlying inflammation.
Zoon’s balanitis presents as persistent, well-defined glassy red patches on the penis and/or foreskin. This condition only tends to occur in uncircumcised men. Diagnosis is often made clinically but a skin biopsy is sometime required to rule out other diagnoses. Zoon’s balanitis is often seen in the context of lichen sclerosus (see above). Treatment is with a combination of soap substitutes, barrier creams and a topical corticosteroid cream.
Psoriasis is a chronic scaly inflammatory skin condition that affects around 2% of the population. Anogenital psoriasis can affects skin on the pubic area, penis, scrotum, inguinal folds, natal cleft, perianal skin and buttocks. Psoriasis affecting these areas can be aggravated by friction and contact with urine and faeces. It can particularly debilitating and can result in itching, soreness and secondary infection. Treatment of psoriasis in these areas are similar to that of psoriasis on other parts of the body, but extra care has to be taken given the sensitive nature of genital skin.
Genital warts are common and caused by the human papillomavirus (HPV). They present and skin-coloured, pink or brown bumps with an irregular surface texture on the genital skin and can be sexually transmitted. Warts usually appear a few months after infection but may also appear years later. They can be treated with topical treatment (e.g. imiquimod cream), cryotherapy or curettage and cautery.
Molluscum contagiosum is a skin infection caused by a pox virus and presents with small skin-coloured bumps on the skin. It is caught by close skin to skin contact and the genital area is a common site of infection. Treatment options range from topical therapy to cryotherapy.
Scabies is caused by a mite that burrows in the skin surface causing a very itching rash on the body. It is often caught by close skin to skin contact and may also be sexually transmitted. On the penis and scrotum, it can cause inflamed itchy bumps. Scabies is usually treated with topical permethrim. Unresponsive or resistant scabies can be treated with oral ivermectin.
Genital herpes can present with a cluster of small blisters and/or ulceration. The ulcers can occur on the glans, foreskin and shaft of the penis. They are usually sore and can last for a couple of weeks. Repeat attacks tend to occurs in the same area. The diagnosis can usually be made clinically, but a viral swab can be taken to confirm the diagnosis. Treatment with oral aciclovir speed up recovery and preventative courses of aciclovir are sometimes given if attacks are very frequent or debilitating.
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Our experienced dermatologists who have a special interest in penile dermatosis will assess your condition, help to diagnose the problem and recommend appropriate treatment. Most conditions can be diagnosed by a thorough clinical assessment. Sometimes a skin swab or a skin scraping may need to be taken and occasionally a skin biopsy may also need to be taken to clarify the diagnosis.