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Skin peeling on penis head, area is pink. On steroid cream. Pityriasis lichenoides?

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Practicing since : 2005
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Hi I have a question about PLEVA (Pityriasis lichenoides). I have had this skin peeling on the head of my penis. Initially it was very small, but with time it has gotten a bit bigger and started spreading to other areas along the trunk. The area looks light pink. I went and saw a dermatologist. He noticed these very slight spots on my skin on my body and had a biopsy done. He said he thought the spots on my body were the same as on my penis. The results came back as possibly being PLEVA. The slight red spots on my skin have not had any drying or scalping like my penis has. My doctor gave me a steroid cream which I have applied for a few days now. I don't think that what is on my body is the same as what is on my penis. I would appreciate any opinions.
Posted Tue, 22 May 2012 in Skin Hair and Nails
 
 
Answered by Dr. Sudarshan 4 hours later
Hi Dear XXXXXXX ,

Thanks for your query.

Pityriasis lichenoides is an uncommon rash .
The condition can range from a relatively mild chronic form to a more severe acute eruption.
The mild chronic form, known as pityriasis lichenoides chronica (PLC), is characterised by the gradual development of symptomless, small, scaling papules that spontaneously flatten and regress over a period of weeks.
At the other end of a continuous clinical spectrum of pityriasis lichenoides is the acute form of the condition.
This is characterised by the abrupt eruption of small scaling papules that develop into blisters and crusted red-brown spots. This acute form is known as pityriasis lichenoides et varioliformis acuta (PLEVA).


Treatment of this condition contains topical corticosteroid application.
Oral antibiotics like erythromycin and phototherapy like NBUVB therapy.

In your case I would like to know

1.since when you have this rash?
2, Are you on any drugs presently?
3. Any oral lesions you have?
4.Genital lesions are ulcers or raised lesions?
5,Are they pigmented?
6. Do you have any scalp or nail abnormality?
7.Do you have any other symptoms like fever/sore throat/joint pain?

Pathology report is actually inconclusive,apart from PLEVA there can be no. of other possibilities.
Clinical co relation is necessary for diagnosis.

A review of biopsy slide may be necessary.


Please reply to the above questions to help you further.



Photographs of skin bumps (close up, distant and lateral)and penile lesions
in good light can be helpful.

Awaiting your response.
Regards
Dr Sudarshan
Above answer was peer-reviewed by
 
Follow-up: Skin peeling on penis head, area is pink. On steroid cream. Pityriasis lichenoides? 21 hours later
Dear Dr. XXXXXXX

Thank you for your reply. In response to you questions:

1.since when you have this rash?
The rash started very small on my penis head. It was only a rash. Eventually it started slightly scalping but was never raised. It still does not appear raised. However, it has become considerably larger and sheds skin every week or so and has become redder. After sex, the rashed area on the penis temporarily becomes exceptionally red almost color of blood. There is no pain or sensitivity. In addition, there is a bit of redness on the trunk of my penis. I will take pictures but I don't know how I can send them to you.

2, Are you on any drugs presently?
No

3. Any oral lesions you have? No

4.Genital lesions are ulcers or raised lesions? no, but on the right side of my penis head, there is minor scalping/crusting that occurs on occasion. No redness, like the main lesion on my penis head

5,Are they pigmented? There is pigmentation on the skin

6. Do you have any scalp or nail abnormality? no

7.Do you have any other symptoms like fever/sore throat/joint pain? no

I will try and get you photos and the name of the medication the doctor has given me. Please let me know if you can give me any assessments based on what the doctor has given me. Please also let me know where I can email or upload the photos to.

Thank you for your assistance.
 
 
Answered by Dr. Sudarshan 2 hours later
Hi XXXXXXX,
Thanks for getting back.

After going through your description my Impression is it can be either persistent Pityriasis rosea or Parapsoriasis.
Both are low grade proliferative conditions you must apply moisturizers liberally and apply topical corticosteroid cream given to you.

Photos can be uploaded by section on right hand side of this window in MY REPORTS area.

Photos will be helpful in guiding you further.

Wishing you speedy recovery

Regards
Dr Sudarshan
Above answer was peer-reviewed by
 
Follow-up: Skin peeling on penis head, area is pink. On steroid cream. Pityriasis lichenoides? 17 hours later
Thank you Dr. XXXXXXX for your response. Your impression was that I might have Pityriasis rosea or Parapsoriasis. I am currently applying Fluticasone Propionate cream twice a day to the affected genital area. Can you please let me know if you think this is a proper cream? In addition, I will be preparing some images of the affected areas and send them to you. Awaiting your response and thanks for your assistance.
 
 
Answered by Dr. Sudarshan 3 hours later
Hi ,

Thanks for writing back.

Fluticasone propionate is a mild to moderate potency steroid and you can apply it safely on genital skin.
Apply it once daily.

Apply moisturizers twice daily.

Wishing you speedy recovery.

Regards
Above answer was peer-reviewed by
 
Follow-up: Skin peeling on penis head, area is pink. On steroid cream. Pityriasis lichenoides? 3 hours later
Hi Dr. XXXXXXX

I have uploaded a photo of the effected area on my penis. Please review and let me know whether applying Fluticasone Propionate cream twice a day to the affected genital area is a right start. Also, please let me know if you received the photo. Thank you.
 
 
Answered by Dr. Sudarshan 1 hour later
Hi ,

Thanks for uploading image.

Ive gone through it.

Fluticasone propionate can be applied on the lesion.

You can apply it safely once a day on genital skin.

Regards
Above answer was peer-reviewed by
 
Follow-up: Skin peeling on penis head, area is pink. On steroid cream. Pityriasis lichenoides? 21 hours later
Thank you for your response Dr. Sudarshad, based on the image I sent you, what is your best diagnosis of what the rash could be? How long should I apply the Fluticasone propionate? Also, if the cream does not get rid of the rash after a few weeks, what would you recommend as the next step?
 
 
Answered by Dr. Sudarshan 26 hours later
HI Dear,

Based on the image parapsoriasis is the main differential that comes to my mind.

You can apply fluticasone for 2-3 weeks.

If your lesions do not get cured after 3 -4 weeks a re biopsy of lesion must be taken and re evaluated.


wishing you speedy recovery.

Regards
Above answer was peer-reviewed by
 
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