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White patches on the penis, no pain, tried clotrimazole and betnovate, biopsy suggested, history of vitiligo. What is the problem?

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Hi, I am a 23 year old male, I have a few patches of white/grey skin on the tip of my penis (glans (glands)). I have had the problem for about 4 years. It does not cause any pain, it is really just the appearance. I am still a virgin so it is not sexually transmitted. I first tried Clotrimazole 2% cream which didn't work, I then saw my doctor and they gave me some Betnovate Ointment 0.1% cream which again didn't work. My doctor says it is not causing any harm and is just how it looks, but said I could see a dermatologist or a biopsy if I wanted. I am not sure I want to get a biopsy, but I am still unhappy with the appearance of this problem. Also note I also suffer from Vitiligo on other parts of body(e.g. hands), so not sure if this could be connected. Are you able to tell from the photos I have posted what the condition could be? Or if there is anything else I could try? Any information would be very useful. Many thanks.

Sorry forgot to write before, here is the picture I posted:
Posted Thu, 26 Apr 2012 in Skin Hair and Nails
Answered by Dr. Rohit Batra 29 hours later

I have seen the pictures sent by you. It was indeed of great help.

As far as the lesion is concerned it is not completely depigmented as in a typical case of vitiligo. The lesion can be ""Pre-Vitiligo" suggesting that you are develpoing vitiligo lesions which are common on genitals in patient suffering from the disease.
Your lesions are asymptomatic suggesting that they are not a fungal or some other kind of infection.

Another condition affecting glans and having a presentation similar to vitilgo is Lichen Sclerosis Atrophicus in which there is also a slight hardening of affected skin.

A biopsy is a must to come to a confirmed diagnosis and you should get it done for a proper treatment especially if there is gradual increase in extent of lesions.

Hope I have answered your query. Should you have any more queries eel free to write back, I will address them promptly.

Hope this helps.

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