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Noticed Bumps On Penis. Diagnosed Balanitis And Prescribed Clotrimazole. What Could This Be?
Question: Hi. I would be grateful for your advice.
About a year ago I noticed bumps on the glans of my penis, as well as very dry and flaky skin. There appeared to be a very tiny black pixel-sized center to some of them. I went to Planned Parenthood immediately and had a full STD blood panel done. It was not Herpes or Chlamydia, or anything else they tested for. The doctor suggested it was Balanitis, and she prescribed Lamisil. She wasn't sure about the bumps. Thrilled, however, that it wasn't Herpes, I proceeded to apply the Lamisil. Indeed everything cleared up, but soon returned. By now I was also experiencing chaffing.
Next I went to dermatologist, who suggested I was having an allergic reaction. She told me to take Benadryll. You can imagine how effective that was. Time went on and I began to notice the rim of my glans looked darker than the middle, and it was inflamed.
Next I began to research my symptoms online, and I found what I had looked exactly like a male yeast infection. This made sense as my girlfriend had had a pretty bad one, and I am uncircumcised. I first began a strict Candida diet, supplemented by probiotics, which actually was the best thing I've ever done. I noticed overall improvements in energy, memory, and weight immediately and I continued that diet religiously for 6-8months. I am on a slightly less intensive version now. I used Canesten on my penis, and then several feminine yeast infection products. Each appeared to work right away but the symptoms returned shortly thereafter.
So I went to a third doctor, a general practitioner, who agreed that it could be a yeast infection but took another blood panel anyway. She prescribed me 1 tablet of Fluconazole (150mg) and another cream suggested I keep trying the Monistat I had been using. No dice.
So I went to a 4th doctor, a urologist, who diagnosed me (visually) with Balanitis and prescribed Clotrimazole with the steroid Betamethasone. No dice.
It has been about a year now! As of now the chaffing is long gone, and the color is back to normal as well, but those cursed bumps show up every time I get an erection. The only other thing I can think of is warts, but the urologist was certain they weren't (because they are only present when erect and there is nothing on the shaft). Or possibly Tyson's glands?
I do hope you can help. It is very hard to go around feeling like this.
Sincerely,
Me
***I'm a 35 year old, straight male, uncircumsised, and was in a monogamous relationship. We used condoms every time, and I would always wash thoroughly after sex, but there was exterior contact before penetration.
About a year ago I noticed bumps on the glans of my penis, as well as very dry and flaky skin. There appeared to be a very tiny black pixel-sized center to some of them. I went to Planned Parenthood immediately and had a full STD blood panel done. It was not Herpes or Chlamydia, or anything else they tested for. The doctor suggested it was Balanitis, and she prescribed Lamisil. She wasn't sure about the bumps. Thrilled, however, that it wasn't Herpes, I proceeded to apply the Lamisil. Indeed everything cleared up, but soon returned. By now I was also experiencing chaffing.
Next I went to dermatologist, who suggested I was having an allergic reaction. She told me to take Benadryll. You can imagine how effective that was. Time went on and I began to notice the rim of my glans looked darker than the middle, and it was inflamed.
Next I began to research my symptoms online, and I found what I had looked exactly like a male yeast infection. This made sense as my girlfriend had had a pretty bad one, and I am uncircumcised. I first began a strict Candida diet, supplemented by probiotics, which actually was the best thing I've ever done. I noticed overall improvements in energy, memory, and weight immediately and I continued that diet religiously for 6-8months. I am on a slightly less intensive version now. I used Canesten on my penis, and then several feminine yeast infection products. Each appeared to work right away but the symptoms returned shortly thereafter.
So I went to a third doctor, a general practitioner, who agreed that it could be a yeast infection but took another blood panel anyway. She prescribed me 1 tablet of Fluconazole (150mg) and another cream suggested I keep trying the Monistat I had been using. No dice.
So I went to a 4th doctor, a urologist, who diagnosed me (visually) with Balanitis and prescribed Clotrimazole with the steroid Betamethasone. No dice.
It has been about a year now! As of now the chaffing is long gone, and the color is back to normal as well, but those cursed bumps show up every time I get an erection. The only other thing I can think of is warts, but the urologist was certain they weren't (because they are only present when erect and there is nothing on the shaft). Or possibly Tyson's glands?
I do hope you can help. It is very hard to go around feeling like this.
Sincerely,
Me
***I'm a 35 year old, straight male, uncircumsised, and was in a monogamous relationship. We used condoms every time, and I would always wash thoroughly after sex, but there was exterior contact before penetration.
Hello Sir,
Welcome and thanks for posting your query to Healthcare Magic. Myself Dr S K Kanodia and will try to provide you the best of information regarding your query.
After reading your query, I can make out that you are quite stressed regarding the problem over your penile skin. Any problem over genital region is definitely a thing of concern for all the males. As I read your query thoroughly and saw all the pictures, (especially health1-1) makes the best possibility of "Candidal balanoposthitis". It starts as mild burning sensation followed by redness and later on whitish flakes over the skin. If the condition is not taken care of then leads to small cuts over prepucial skin and later on difficulty in retraction of the skin backwards.
It is quite clear from your history that the problem is present recurrently since one year. You should understand that this it is a common condition in uncircumcised males because of the fact that area of glans and prepucial skin is always moist. This moist skin is the favorable environment for the growth of fungus but more predisposed in individuals where either hygiene is not proper, due diabetes or in cases of low/fluctuating immunity and lastly if the partner is infected. Therefore, to guide you further I would like to ask little information related with this problem:
1. Have you gone for your blood sugar check in last 1 year?
2. Have you experienced any other skin problem in last few years?
3. Does your partner have any whitish or curdy or any kind of discharge problem
I hope you would not be bothered to reply the above. Waiting for your reply so that I can guide you further.
Regards.
Dr Sanjay Kumar Kanodia
MD (Dermatology & Sexually Transmitted Diseases)
Welcome and thanks for posting your query to Healthcare Magic. Myself Dr S K Kanodia and will try to provide you the best of information regarding your query.
After reading your query, I can make out that you are quite stressed regarding the problem over your penile skin. Any problem over genital region is definitely a thing of concern for all the males. As I read your query thoroughly and saw all the pictures, (especially health1-1) makes the best possibility of "Candidal balanoposthitis". It starts as mild burning sensation followed by redness and later on whitish flakes over the skin. If the condition is not taken care of then leads to small cuts over prepucial skin and later on difficulty in retraction of the skin backwards.
It is quite clear from your history that the problem is present recurrently since one year. You should understand that this it is a common condition in uncircumcised males because of the fact that area of glans and prepucial skin is always moist. This moist skin is the favorable environment for the growth of fungus but more predisposed in individuals where either hygiene is not proper, due diabetes or in cases of low/fluctuating immunity and lastly if the partner is infected. Therefore, to guide you further I would like to ask little information related with this problem:
1. Have you gone for your blood sugar check in last 1 year?
2. Have you experienced any other skin problem in last few years?
3. Does your partner have any whitish or curdy or any kind of discharge problem
I hope you would not be bothered to reply the above. Waiting for your reply so that I can guide you further.
Regards.
Dr Sanjay Kumar Kanodia
MD (Dermatology & Sexually Transmitted Diseases)
Above answer was peer-reviewed by :
Dr. Shanthi.E
Thank you, doctor, for your speedy response.
I had my fasting blood sugar checked at the third doctor (November 2012): Glucose, Serum = 95mg/dl
*The reference range on my report is 65-99.
The test also says that no fungus was identified, but the candida albicans result reads "no aptima transport received", and I remember the doctor saying she didn't think there was enough skin or moisture present at the time to get a good test. The only flag on the blood test is for a high BUN/creatine ratio, "23" on a scale of 6-20. I have no idea what this means.
I have had some other, minor, skin issues. Upon drinking alcohol, my back, chest, and face would become deep red; like a sunburn, not the common blushing that is to be expected. I've since cut out alcohol completely.
I have also had a couple of times where the skin on one or both of my hands would completely dry out, even turn white. Lotion didn't help, but this did go away on it's own pretty quickly each time. I have photos of this as well, but I don't believe the site will let me upload any more.
And I have always had pretty oily skin. I still get pimples once in a while. This made me wonder about the possibility of some kind of blocked pores, as some of the bumps appear to have a tiny black center, which I can only see when erect and looking very closely. Unfortunately it's nothing I can squeeze out (like a blackhead).
As far as white discharge with my girlfriend, she did have such a yeast infection once, but I was sure there was no external contact that time, which is not to say that I didn't contact this to some degree on other encounters. I was, however, always very fastidious about cleanliness, always washing after sex. We broke up in July of last year, and I have been celibate since.
Presently I am extra vigilant about staying clean and dry. I have tried both probiotic and, recently, anti-bacterial soaps. I have even tried using acne pads (2% salicylic acid) and hydrogen peroxide after I shower, followed by a dry cotton pad to take off any excess moisture. I even tried washing with XXXXXXX cider vinegar and salt baths. I have read that vinegar will turn warts white, which didn't happen in my case, but i am not sure how dependable that test is.
I have seen a lot of improvement in everything but those bumps. They don't itch or hurt or ooze, but they won't go away. Unfortunately, the doctors I have been seeing keep prescribing creams that seem only to treat the symptoms.
Is there anything else this could be, or anything else I can do? Are there medications I should inquire about, antibiotics or antifungals? I hate to keep going back to these doctors blind and keep getting sent away with another prescription for cream. My insurance changed this year and there is no coverage for office visits, pharmacy, or anything else before I reach my 1500 dollar deductible.
Sincerest thanks in advance for any suggestions you might have...
I had my fasting blood sugar checked at the third doctor (November 2012): Glucose, Serum = 95mg/dl
*The reference range on my report is 65-99.
The test also says that no fungus was identified, but the candida albicans result reads "no aptima transport received", and I remember the doctor saying she didn't think there was enough skin or moisture present at the time to get a good test. The only flag on the blood test is for a high BUN/creatine ratio, "23" on a scale of 6-20. I have no idea what this means.
I have had some other, minor, skin issues. Upon drinking alcohol, my back, chest, and face would become deep red; like a sunburn, not the common blushing that is to be expected. I've since cut out alcohol completely.
I have also had a couple of times where the skin on one or both of my hands would completely dry out, even turn white. Lotion didn't help, but this did go away on it's own pretty quickly each time. I have photos of this as well, but I don't believe the site will let me upload any more.
And I have always had pretty oily skin. I still get pimples once in a while. This made me wonder about the possibility of some kind of blocked pores, as some of the bumps appear to have a tiny black center, which I can only see when erect and looking very closely. Unfortunately it's nothing I can squeeze out (like a blackhead).
As far as white discharge with my girlfriend, she did have such a yeast infection once, but I was sure there was no external contact that time, which is not to say that I didn't contact this to some degree on other encounters. I was, however, always very fastidious about cleanliness, always washing after sex. We broke up in July of last year, and I have been celibate since.
Presently I am extra vigilant about staying clean and dry. I have tried both probiotic and, recently, anti-bacterial soaps. I have even tried using acne pads (2% salicylic acid) and hydrogen peroxide after I shower, followed by a dry cotton pad to take off any excess moisture. I even tried washing with XXXXXXX cider vinegar and salt baths. I have read that vinegar will turn warts white, which didn't happen in my case, but i am not sure how dependable that test is.
I have seen a lot of improvement in everything but those bumps. They don't itch or hurt or ooze, but they won't go away. Unfortunately, the doctors I have been seeing keep prescribing creams that seem only to treat the symptoms.
Is there anything else this could be, or anything else I can do? Are there medications I should inquire about, antibiotics or antifungals? I hate to keep going back to these doctors blind and keep getting sent away with another prescription for cream. My insurance changed this year and there is no coverage for office visits, pharmacy, or anything else before I reach my 1500 dollar deductible.
Sincerest thanks in advance for any suggestions you might have...
Hello sir welcome again to the forum.
Thanks for so detailed reply regarding your problem. Now after confirming all the points given by you it is quite clear that the problem is most probably “candidal balanoposthitis” but adding to it “inappropriate and overmedication” in same. As per the clinical picture as well as the symptoms enumerated by you candidal infection is present but by the usage of too many things, the normal homeostasis and environment of the penile skin is totally changed.
To understand it scientifically and logically-
1.Our normal skin homeostasis do not favour the growth of fungus, but by the use various chemicals injudiciously or in high amount, the normal skin homeostasis changes leading to fungal growth. As you continuously used one or the other medicated and other products lead to so the skin milieu became weakened.
2. In your case this is also followed by thinning of the skin which actually leads to prominence of underlying veins and blood vessels over the area where you actually feel the kind of bumps you mentioned.
3.To explain you simply, the thinnest skin in the body is present at the penile area and that too the mucosal surface on and around glans penis, so otherwise also in people with normal skin also do feel prominence of skin at various places around the glans and is more prominent during erection because of the engorgement of underlying blood vessels. So you try and understand that the bumps for which you are worried is neither Tysons glands and nor anything serious but are simple prominent blood vessels only.
4.Regarding BUN/ urea ratio it is nothing to do with our current problem and is not anything serious in it. It just shows that either you are dehydrated (drinking less of water) or have a lot of stress.
Now coming on to the problem of balanoposthitis again there are no such risk factors are present in you (blood sugar is well in normal range). So the only problem which I suspect is with
a) Over medication
b) Use of steroid creams which makes the situation worse
c) Resistance to the current therapy ( as you responded well to initial therapy with terbinafine)
I am suggesting some points regarding betterment of the situation:
1. Do not use anything from your side. Stop all the medications as well as other things which you enumerated for around minimum 7 days to 21 days of period so that skin can return in normal situation.
2. Do saline compression over the affected area at least 3-4 times a day. Use normal saline for the same, if you can not buy that then can prepare it at home also by adding a pinch of salt in a glass of boiled water. You can use XXXXXXX warm water soaked in cotton for 5 minutes each time.
3. You can add up “gentian violet paint” in the saline water in proportion of around 10- 15 drops in a glass of water for better efficacy. This gentian violet paint is age old simple antifungal and antibacterial without any resistance to it.
4. Apply plain antifungal cream in a very thin layer so that it should not be visible by naked eye along with above measures enumerated.
5. If you are not getting anything better by above measures then you need to consult a good dermatologist who can do culture and sensitivity of the area for the fungus and prescribe you the latest and best antifungal in form of oral and topical antifungals.
Regarding problem of your hands you are most welcome to ask further question for the same. For that you have a feature to upload images by yourself at the right side of the query page, please utilize that so that I can answer your queries for the same. Or else, you can send as an attachment to YYYY@YYYY with the subject as "Attn: Dr. Sanjay Kumar Kanodia)
Hope I have answered your query. If you have any further questions, I will be happy to help. Wish you good health.
Regards,
Dr Sanjay Kumar Kanodia
(MD- Dermatology & STD)
Thanks for so detailed reply regarding your problem. Now after confirming all the points given by you it is quite clear that the problem is most probably “candidal balanoposthitis” but adding to it “inappropriate and overmedication” in same. As per the clinical picture as well as the symptoms enumerated by you candidal infection is present but by the usage of too many things, the normal homeostasis and environment of the penile skin is totally changed.
To understand it scientifically and logically-
1.Our normal skin homeostasis do not favour the growth of fungus, but by the use various chemicals injudiciously or in high amount, the normal skin homeostasis changes leading to fungal growth. As you continuously used one or the other medicated and other products lead to so the skin milieu became weakened.
2. In your case this is also followed by thinning of the skin which actually leads to prominence of underlying veins and blood vessels over the area where you actually feel the kind of bumps you mentioned.
3.To explain you simply, the thinnest skin in the body is present at the penile area and that too the mucosal surface on and around glans penis, so otherwise also in people with normal skin also do feel prominence of skin at various places around the glans and is more prominent during erection because of the engorgement of underlying blood vessels. So you try and understand that the bumps for which you are worried is neither Tysons glands and nor anything serious but are simple prominent blood vessels only.
4.Regarding BUN/ urea ratio it is nothing to do with our current problem and is not anything serious in it. It just shows that either you are dehydrated (drinking less of water) or have a lot of stress.
Now coming on to the problem of balanoposthitis again there are no such risk factors are present in you (blood sugar is well in normal range). So the only problem which I suspect is with
a) Over medication
b) Use of steroid creams which makes the situation worse
c) Resistance to the current therapy ( as you responded well to initial therapy with terbinafine)
I am suggesting some points regarding betterment of the situation:
1. Do not use anything from your side. Stop all the medications as well as other things which you enumerated for around minimum 7 days to 21 days of period so that skin can return in normal situation.
2. Do saline compression over the affected area at least 3-4 times a day. Use normal saline for the same, if you can not buy that then can prepare it at home also by adding a pinch of salt in a glass of boiled water. You can use XXXXXXX warm water soaked in cotton for 5 minutes each time.
3. You can add up “gentian violet paint” in the saline water in proportion of around 10- 15 drops in a glass of water for better efficacy. This gentian violet paint is age old simple antifungal and antibacterial without any resistance to it.
4. Apply plain antifungal cream in a very thin layer so that it should not be visible by naked eye along with above measures enumerated.
5. If you are not getting anything better by above measures then you need to consult a good dermatologist who can do culture and sensitivity of the area for the fungus and prescribe you the latest and best antifungal in form of oral and topical antifungals.
Regarding problem of your hands you are most welcome to ask further question for the same. For that you have a feature to upload images by yourself at the right side of the query page, please utilize that so that I can answer your queries for the same. Or else, you can send as an attachment to YYYY@YYYY with the subject as "Attn: Dr. Sanjay Kumar Kanodia)
Hope I have answered your query. If you have any further questions, I will be happy to help. Wish you good health.
Regards,
Dr Sanjay Kumar Kanodia
(MD- Dermatology & STD)
Above answer was peer-reviewed by :
Dr. Mohammed Kappan
I understand, but please keep in mind that the medications I've tried have been applied over the course of a year, and all except one have been plain anti-fungals. In fact, the first six months were nothing but diet and hygiene improvement.
The steroid was only the very last one, as prescribed. In between all of these treatments were at least 21 days of no medication at all.
And the bumps did not come after the treatment. They were the reason I sought out treatment to begin with.
I don't know what turbinafine is? Are you confusing my inquiry with another persons? But all of the treatments had the same, positive results, at first.
I'll try yet another period of no treatment, as well as the saline compression (assuming this is different than the salt baths I've already tried). But this is where I keep ending up, and at the end of the day I'm a little bit poorer and I still have bumps on my penis.
If candidal balanitis is cured by salt compression and over-the-counter antifungal creams, then this is clearly not it or it would be long gone by now. As this is my last allowed inquiry, please advise as to what to do if this doesn't go away, besides going back to another doctor, getting another cream, and starting another year of this.
The steroid was only the very last one, as prescribed. In between all of these treatments were at least 21 days of no medication at all.
And the bumps did not come after the treatment. They were the reason I sought out treatment to begin with.
I don't know what turbinafine is? Are you confusing my inquiry with another persons? But all of the treatments had the same, positive results, at first.
I'll try yet another period of no treatment, as well as the saline compression (assuming this is different than the salt baths I've already tried). But this is where I keep ending up, and at the end of the day I'm a little bit poorer and I still have bumps on my penis.
If candidal balanitis is cured by salt compression and over-the-counter antifungal creams, then this is clearly not it or it would be long gone by now. As this is my last allowed inquiry, please advise as to what to do if this doesn't go away, besides going back to another doctor, getting another cream, and starting another year of this.
Dear Sir,
Welcome again to the forum.
I can understand your great concern about your problem. First and foremost reassure yourself as the problem which you are facing is very common condition which we see in our day to day practice. There is nothing serious in this.
As discussed before there were two important things in your problem- the one is the simple fungal infection and the other the other bumps which you feel are the normal blood vessels as I told you. The picture which you have sent is quite clear to show the first one. It responded well to the previous treatment with all the antifungal treatments you have taken. Now it depends from person to person to have recurrence of the problem. In usual and normal circumstance also we do find cases of “recurrence”.
As discussed before the chances of recurrence is also be due insensitivity of the drug to the body which we call as “drug resistance”. For reducing recurrence as well as resistance it is better to reduce the drug slowly and not abruptly. To tell it simply - you apply the drug for two times for 7 days then one time for next 7 days and then apply alternate days for next couple of days. If you see even slightest of the activity you can use the medicine at that time. But don’t stop it abruptly or suddenly. The latest antifungal with best activity is “sertaconazole” which you can use under medical advise.
For the query regarding “terbinafine”, I am not at all confusing your query with any other. “Terbinafine” which I have mentioned is the main content in the antifungal cream “lamisil” which you had used initially.
For bumps also I again reassure you that these are simple normal blood vessels (as per the description given by you). These can be prominent at one time and can regress the other time as per the erection and filling of the blood vessels. Medicines have nothing to do with it. So kindly take it positively.
Lastly reassure yourself for the normal process of the body as stress itself cause a lot of changes. Even if you have any query left you are most welcome to ask. I think you still have one more free follow up remaining. I will be most happy to help and answer you.
"With best health wishes"
Regards,
Dr Sanjay Kumar Kanodia
(MD- Dermatology & Sexually Transmitted Diseases)
Welcome again to the forum.
I can understand your great concern about your problem. First and foremost reassure yourself as the problem which you are facing is very common condition which we see in our day to day practice. There is nothing serious in this.
As discussed before there were two important things in your problem- the one is the simple fungal infection and the other the other bumps which you feel are the normal blood vessels as I told you. The picture which you have sent is quite clear to show the first one. It responded well to the previous treatment with all the antifungal treatments you have taken. Now it depends from person to person to have recurrence of the problem. In usual and normal circumstance also we do find cases of “recurrence”.
As discussed before the chances of recurrence is also be due insensitivity of the drug to the body which we call as “drug resistance”. For reducing recurrence as well as resistance it is better to reduce the drug slowly and not abruptly. To tell it simply - you apply the drug for two times for 7 days then one time for next 7 days and then apply alternate days for next couple of days. If you see even slightest of the activity you can use the medicine at that time. But don’t stop it abruptly or suddenly. The latest antifungal with best activity is “sertaconazole” which you can use under medical advise.
For the query regarding “terbinafine”, I am not at all confusing your query with any other. “Terbinafine” which I have mentioned is the main content in the antifungal cream “lamisil” which you had used initially.
For bumps also I again reassure you that these are simple normal blood vessels (as per the description given by you). These can be prominent at one time and can regress the other time as per the erection and filling of the blood vessels. Medicines have nothing to do with it. So kindly take it positively.
Lastly reassure yourself for the normal process of the body as stress itself cause a lot of changes. Even if you have any query left you are most welcome to ask. I think you still have one more free follow up remaining. I will be most happy to help and answer you.
"With best health wishes"
Regards,
Dr Sanjay Kumar Kanodia
(MD- Dermatology & Sexually Transmitted Diseases)
Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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