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Suggest Treatment For Allergic Dermatitis Of Penile Area

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Posted on Thu, 5 Jun 2014
Question: Dear, Dr. XXXXXXX XXXXXXX Kanodia

I'm a 21 year old male and I have had what was diagnosed a fungal infection/Yeast infection/ Balanitis for over a year now, I believe it was contracted from unprotected sex, a month or so before that I had gotten a rubber burn from the condom and had a small rash that went away mostly, but came back after this infection. I have seen 3 doctors, 1 being a urologist, and the other 2 where at the local STD center. They all have diagnosed it as a fungal infection, Candida Yeast infection from the 2 doctors, the Urologist calls its Balanitis for a male. I started treatment in december, I have tried many treatments with no luck, it would seem like it would get better in the beginning with the symptoms going down but the rash was never fully healed, I have seen improvements but nothing that would clear it up completely.

First when i was diagnosed in dec 2013, I was told to go get Over the counter topicals, So I got monistat 7 day, it relieved symptoms but did not get rid of the redness and rash and stopped working eventually. I than tried natural remedies but they did not seem to help at all. tried other monistats like 3 and 1 in hopes but did not help.

I went back to the Std center in March 2014 and thats when they gave me 1 Fluconazole tab 150mg. It relieved symptoms but never cleared up.
I have tried multiple single dose Fluconazole tabs 150mg 3 days apart at first with a little symptom relief. Than they told me to go to a Urologist or skin specialist so I went to a nearby Urologist. The Urologist put me on 50mg/day Fluconazole for 1 month with OTC Jock Itch topical treatment Equate. Which is 1% Terbinafine and it helped a little but still not nothing near cured. I just went back to the Urologist 5/5/14 and he put me on another 2 months of 50mg/day fluconazole with the equate. I really feel that this isn't working and I am nervous to wait another 2 months to see what happens, since every treatment from the multiple doctors assured me it would clear up, but have not. I dont know what else to try other than what the doctor told me, after that first month there was very very little improvement. So i feel that it will be the same result and I have spent so much money well over $700 to try and get rid of this and cannot afford to continue with these expensive doctor visits and medications since i am just a college student. I'm really starting to lose all hope at this point and getting depressed from it, this has affected me for a year and a half already. I have spent countless hours researching and trying find everything about my problem, I have found information such as A candida Diet, supplements to kill off yeast, i don't know if I have a systemic infection or not. The most useful information I have found which someone with a similar situation said they were cured with. I found it on this forum:
http://www.medhelp.org/posts/STDs/balanitis-wont-go-away/show/522670

They said they used, which i may want to try if it seems to fit my problem.
Sertaconazole Nitrate 2 w/w cream (Onabet) to use twice daily

I would very much like to send pictures to you so you can easier help me with my problem. Just let me know.

My current symptoms are redness patches, itching sometimes, burning sometimes, mostly just a uncomfortable feeling not much pain, I do feel my urethra has problems on the inside, It does not burn or anything when peeing but it is definitely a discomforting non-normal feeling, small bumps that seem to come and go, scaly skin in some spots, have not noticed much peeling at all (only once when I was in very very cold weather and did not have much water.) Also with the Urethra, I will always drip after peeing, i have to sorta squeeze it out, but it will still have some dripping later on like 5-15 mins or so. not constantly, just like 1 or 2 more drops. Sometimes usually, it is a clear sticky fluid which comes out. When erect it will leak the clear sticky fluid usually. I try to avoid masterbating but sometimes I do, but clean well after. and apply treatment.

So please Dr. XXXXXXX XXXXXXX Kanodia, I really need help, I want to live normally again, and have a normal sex life, I ave not had sex in a year and a half. I have recently gotten a girlfriend after many years single, which I really love and she loves me, she is a virgin and we have not planned on having sex anytime soon, so i really wanted to get treated so when the time comes. Regardless I will not pass it on to her in anyway, I love her to much to do that.

Thank you for taking the time to read this.

Sincerely, XXXX
doctor
Answered by Dr. Sanjay Kumar Kanodia (9 hours later)
Brief Answer:
Kindly send details and pictures

Detailed Answer:
Hello XXXXXXX

Welcome and thanks for posting your query to the forum.

I have gone through your complete query and read all the concerns including each and every point related to your health query.

I can make out that you are in great agony since more than last 5 months. I promise you that I will try to help you best regarding your problem.

You have nicely elaborated your query so that I can presumptively think in one particular direction. But to help you best I request you to send good resolution pictures of the affected area. For that you have a feature to upload images by yourself at the right side of the query page. Or else, you can send as an attachment to YYYY@YYYY with the subject as "Attn: Dr. Sanjay Kumar Kanodia.


Also kindly tell me certain important points:

- other than redness have you ever felt any kind of discharge from the penile site.

- Any history of sore formation or ulceration on the site.

- Severity of itching and pain- mild/ moderate/severe/unbearable.

- Any tests done in last 5 months and the results.

I again reassure you that I will not leave any stone unturned to help you best regarding your problem.

Hope to hear soon from your side.

Wish you good health.

Regards,
Dr Sanjay Kumar Kanodia
(MD- Dermatology & Sexually Transmitted Diseases)
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sanjay Kumar Kanodia (7 hours later)
Thank you for such a quick reply Doctor.

I didnt forget to mention a few things. My ball sack is also red, I will send pictures, not sure if it is the infection or just irritate from the creams or something else.

Also I am 140 lbs 5'9".

One of my treatments I forgot to mention from March 2014 was "Nystatin and Triamcinolone Acetonide Cream USP" for 10 days use. This steroid cream relieved all symptoms the first 1-3 days than it made it much worse. Causing redness which I have never had before and made the skin look scaly on top of the head.

Also I've tried White vinegar, tea tree oil, I wasn't sure how to use them stopped after a few days.

I recently tried to fast and eat 2-3 table spoons of virgin coconut oil for 2 days with tons of water, as well as apply the oil topically, I only did this for 2 days. I heard coconut oil kills off candida, which I felt worked , it reduced symptoms and redness, and made the area overall look better, but I stopped after the 2 days and continued back to the prescribed stuff after I researched online and found you, to get your inputs.

To answer you questions:

I have not had any discharge from the actual rashes/ red spots. Only after I pee usually, I will have to squeeze to get all of the urine out, and still have a few drops coming a few minutes after I leave the bathroom, and sometimes I would have a clear sticky fluid oozing out too after I pee. And after I get an erection the clear sticky fluid would come out also, which i assume is precum. So the problem is also internal in the urethra, It has never really burned or bothered me much while I pee, I can just feel the discomfort and awkwardness in the Urethra while and after I pee, it is not normal that is for sure it feels inflamed on the inside.

I am not sure if what I have are considered sores, they look like rashes, I have not had any ulcerations. Just redness rashes, small bumps, scaly looking skin, and irritation.

I did have a lot of itching and burning in the past before I seeked treatment, which is the reason I did seek treatment since it became severe. Ever since I started the real treatments in march such as prescription treatments, the burning and itching has not bothered me much at all. I can definitely feel it but it is nothing bad so I would say Mild pain itching and burning. I can definitely feel the rash on the left side of the head, which is the biggest rash.

In december of 2013, I had Gonorrhea and Chlamydia Test done from a urine sample and they both came back negative. This is when I had the first Physical exam, and they ruled out STD's and said that STD tests wouldn't be needed.

I also have a few questions about everything since I have done a lot of research and have found many many ways to treat this if it is what I have.

If this can be cured, will my penis look normal again, or will it have some marks or scaly skin. SOmetimes it looks sooo bad it scares me, and than sometimes it doesn't look to bad at all. Im guessing the blood flow in the area will make it look worse or better at times.

I also have a white spot on the left side of the head towards the center between the glans and the urethra, not sure what it is, I've read skin pigmentation, I'm not sure when it appeared or how, BUt didn't think much of it. I will try to included it in a picture.

Also I have read about many people not being able to get treated for candida and having to do a strict Candida Diet with no sugars, low carbs, no grains, yeasts, fruits ect.. May I have to do something like this? I really rather not it seems to hard to do for me. I am currently taking supplements, one called Candidastat which some people have worked for. It has just arrived so I am not sure how it will work.

A concern is the treatment, it seems like I need something to work internally like some pills, not just topical creams.The fluconazole I am currently on isn't showing any promising improvements, the urologist said I may need to take it for 4-6 months. He really seems like he is unsure about what I had or how to treat it, since on the second visit he was confused why the first month of fluconazole had not worked and sat there thinking for a few on what to do next. and just said more fluconazole.


I really need help, I have spent way to much money out of my pocket already for this. I am willing to spend a bit more since I have saw your reviews and everything and you seem very promising to me compared to any others.

Sorry if I made it unorganized, I just wanted to get as much information in as possible.

I will post a bunch of photos as well as the recent diagnosis paper from the doctor.

Thank you so much for your effort in helping me, if there is any better way to contact you or direct contact please let me know I would like to have contact with you in the future.

Sincerly,XXXX
doctor
Answered by Dr. Sanjay Kumar Kanodia (18 hours later)
Brief Answer:
Not fungal infection;normal redness;can be treated

Detailed Answer:
Hello young man,

Thanks a lot for uploading all the pictures and important informations. After analyzing all the pictures as well as correlating all the facts provided by you, let me give the best information that you do not have fungal infection or any other type of major skin related issue or any type of sexually transmitted disease.

I am really surprised to see the various regimens of treatment as well as self medications done by you last 5-6 months. I can very well understand your part of tensions and agony felt in last couple of months.

You must be wondering that if it is not a fungal infection or any other type infection then what the exact problem is then!!!

Before I come to the exact problem let me guide you certain important points regarding our penile skin:

You should know the fact that our penile skin is the thinnest skin on the body. It is such a thin skin that even the blood vessels are directly visible over it. This redness of the blood vessels is many times confused with some kind of skin problems such as red rash or related thing. In your case also this redness is due to this simple normal phenomenon of the human penile skin.

Adding to it, the thinnest skin of the body over glans is also sensitive to the friction plus the chemicals in day to day life. All these factors also lead to the kind of problem which you are facing.

Mild to moderate redness is quite common in this area because of the friction during sexual intercourse or due to masturbation also. Even the condoms are known to produce redness because of the rubber content as well as certain chemicals on the condoms as lubricants and as fragrance.

Many a times certain soaps or deodorants and sanitizers or even wipes or related items can cause redness and irritation over the area.

In your case you can notice that despite taking antifungal treatment the things are not getting better. In fungal infections of the penile area we find deep red area with mild discharge and a lot of irritation.

As I can thoroughly analyze the pictures at different resolutions I can not find any element of fungal infection. If it was a fungal infection then definitely had got better in this long period of time.

I quite often consult you r kind of cases getting very much anxious for one or the other sexually transmitted diseases especially after unprotected intercourse. But in actual means most of the cases perceive the symptoms of redness or irritation in acute phase of anxiety. Then starts the vicious cycle of visiting one or the other doctors. It is not from the part of money but form the part of mental anguish and distress regarding fear of one or the other infection that disturbs the patient day and night.

Otherwise also in my patients if I suspect of fungal infection then I go for a simple test of KOH mount with culture and sensitivity of the penile area. It gives a clear indication of whether the fungus is present or not. In your case I can not see any such test done in last 5 months.

For the betterment kindly follow the suggestion below:

- STOP ALL TYPES OF TREATMENT AND SELF MEDICATIONS. You can see that I have written the statement in bold letters. It is just because of the fact that over application and injudicious application of multiple products including medications spoils the normal natural environment of penile skin. Our skin harbors millions of good bacteria which prevents the growth of harmful organisms. But on repeated application of one or the other thing it causes disturbance in the normal flora and therefore the type of symptoms which you are feeling.
-Keep your self away from hot and humid climate.

- Take two times bath. Clean the genital area 4 times thoroughly and gently with plane water.

- Wear cotton clothes and cotton undergarments to be changed two times a day. Do not wear any synthetic or tight garments.

- Do not sit continuously for long hours.

- Stop masturbation or any type of sexual activity for few weeks.

For the part of treatment proper:

Take “Gentian violet paint” (GV paint) with normal water in a proportion of 1:10. It means I drop of Gentian violet paint and 10 drops of water or simply 1 teaspoon Gentian violet paint in 1 cup of water. Take a cotton ball and gently do compression. Do cold compression or warm water compresses according to the weather condition.

-For the irritation part you can take oral anti histamine like loratadine (Claritin) for two times for 7 days.

-Don't try to scratch or rub or repeatedly observe the area as can lead to further aggravation of the problem. I quite often see that due to anxiousness young men like you keep on observing and touching the area repeatedly multiple times in day. By doing so the soft penile skin is actually more irritated and looks red.

I reassure you fully that you do not have any kind of infection. You have to distract your mind from any possibility of any type of infection. You and your girlfriend will have best of your future.

“My all best wishes for your healthy life”.
I hope these information's will help you. If you have further queries I will be happy to help.

"Wish you good health and early recovery from the problem"

Regards,
Dr Sanjay Kumar Kanodia
MD (Dermatology & Sexually transmitted diseases)
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sanjay Kumar Kanodia (30 hours later)
Dear Dr XXXXXXX

Thank you so much for your help and XXXXXXX of relief.

I am still worried about a few things and would like to ask some more things. Is there a certain Diagnosis / name you would call this, I would like to know.

If i have had this problem since November 2012. How come it has not showed any signs of clearing up before and only seemed to get worse no matter what if it is just a simple rash. My current symptoms are every now and than I will feel the burning, a mild one around the entire head, mainly where the rashes are the biggest, I have a small looking like cut type rash that I can feel pain from sometimes, again these are mild pains, but still not comfortable. Itching will sometimes get bad where I have to make a movement or just XXXXXXX the area. Not often or too bad.

Is it normal that the entire skin on the head of the penis looks scaly, and patchy with redness? Also you can see the red like bumps/rashes inside the skin, not on the outside, like under the skin.

The main thing i am concerned about is the inside of the Urethra, I can feel it like it is swelled up and irritated, slight burn, very very mild on the inside, also on the tip the skin from the urethra opening will sometimes bulge out a little bit looking inflamed and red, so how will that get treated from the topical. That is my biggest concern it feels internal as well.

I get dripping after I pee, quite a lot at times. Even 10-30 minutes after i peed. Aswell with the clear sticky discharge I will get sometimes after I pee. mainly when i have an erection. How will this get treated and cured?

I am going to delete the current photos and post some new ones so we can be 100% sure, as the other pictures seemed to look mild compared to other times when the rashes are flared up.

Also Doctor, I have a mild case of acne on my face and back, and basically I get it anywhere on my body, like arms and forearms as well, Since your a dermatologist I figured I would ask if you can reccomended anything , it very much seems like my problem is internal/ hormonal acne. I have had it for nearly 8 years, just recently getting treatments such as chemical peels and using harsh products, which irritate a lot, I have gotten about 75% clear so far. but it seems not to be working as well as it first started too. I have scars also from the acne, and my pores are always huge and filled with sebum and dirt and I can squeeze em out all the time.

I use Benzoyl peroxide alongside, vitamin A pro serum, and a mandelic serum. with a mandelic scrub. Is there any vitamins I should take to help or prescriptions.

I will post a few pictures of my face and back, and if you can recommend anything to take orally. since I feel my problem is definitely internal since i have been using these products for over a year and am still breaking out all the time.

If you can help me with my acne problem as well that would be greatly appreciated as this penile rash has devastated me for the past year and a half, and my acne has also devastated me for the past 8 years causing a lot of damage to my lifestyle with depression and socially damaging from when I had bad acne.

Thank you so much for doing this, you put my mind at ease and i can finally relax and not be worried or depressed anymore about this problem.

I will post new photos that are clearer so please take a look again. Thank you for all you are doing. But I must say, the pictures seem to not show how red the actual spots are compared to looking at it in person, maybe my camera is not that good. Let me know if u need higher quality photos.

Sincerely,XXXX


doctor
Answered by Dr. Sanjay Kumar Kanodia (22 hours later)
Brief Answer:
Contact allergic dermatitis of penile area

Detailed Answer:
Hello young man,

Thanks a lot for your follow up queries.

I have gone through all your queries and again revised the pictures thoroughly in higher magnification. After the complete analysis again I want to reassure you that your condition is not related to any infection.

Let you first come out of the aura of being suffering from some serious or non-serious infection. As I guided you before that you do not have any infection and therefore must relax now.

For the part of Medical diagnosis or terminology of your condition- It is known as "contact allergic dermatitis of penile area" or "penile dermatitis". It is quite often encountered entity in modern day practice where we use so many of irritant materials on our skin. As said before that the penile skin is sometimes so sensitive that it causes recurrent rashes. Sometimes when the impact or the concentration is low than it is lower side and when it is more then there is more redness.

Whenever the skin is healing then it forms scaly dry skin which you are feeling. You can get form my points that it sometime becomes recurrent problem till the time there is exposure to one o the other irritant materials. In my patients I have seen that due to mere touching it can get aggravated. That is why I have asked you to not to touch the area.

If you think of fungal infections then you must understand that it is not the picture which you have.

The redness at the urethral opening is a common part due to change of the mucosal skin from penile tip to inside urethra. If at all you feel or suspect that it is an internal infection then there are typical symptoms of severe burning and a lot of difficulty during peeing. Later on it leads to discharge from urethra in infections.

Dripping from urethra is due anxious states and improper peeing. Even in these situations urine itself can irritate the penile skin leading to rash formation. Be relaxed during peeing and completely urinate the entire amount and don't get panicky.

The clear sticky discharge is the simple precum or the normal secretion which all of young men have at your age. Not having the discharge or secretion is a problem my dear young man!!!

Do follow all of my suggestions as in previous mail and get back to normal life.

I can understand your concern for pimples too. It is really distressing for a young man of your age if there is presence of pimples on face.

Before I guide you best regarding your condition let me explain you elaborately regarding pimples- Acne or pimples generally appears at the age of 13-14 years and then almost vanishes by the age of 25 years.

These erupts basically due to hormones (chemicals which are influencing one or other body functions including growth, puberty and development of body in adults) in addition to the influence of certain other factors causing its aggravation. The hormone testosterone and its bye-products play the most important role in high oil secretion and increase the size of oil glands especially in males.

As the pores or ducts of the glands are blocked so it leads to formation of pimples.

There are certain other factors such as application of oily or creamy products, over exposure to sunlight, heat and humidity or due to pinching, popping and squeezing of the pimples also leads to formation of pimples. Once these are healing they leave the most problematic thing which are either marks or scars.

Therefore any of the above factors along with hormones can cause appearance of pimples at the age of 21 years. The hormonal upsurge is highest between 15 -25 years so you have pimples at your age of 21 years. So probably you got some idea regarding your acne.

There are certain suggestions which you can follow:

1. Do not pinch, pop or squeeze any area on face.

2. Do not apply any creamy or oily stuff or any other cosmetics over face.

3. Try to avoid any home remedies suggested by your friends or family members or otherwise self implicated therapies also.

4. Try avoiding situations of direct continuous exposure to sunlight or heat and humidity for long hours. Make your room properly ventilated it will improve the status of pimples.

5. Kindly do not use any antibiotic as self medication.

6. Do not apply any hair oil on scalp or apply in very less amount. Wash your scalp daily with some good shampoo and let there be no dandruff in your scalp (because dandruff itself causes blockage of pores of oil glands and then pimples).

The part of treatment you are taking is quite fine and can follow that. Otherwise in my patients I suggest my patients to start Isotretinoin for long term relief. Isotretinoin is drug of choice which acts on all aspect of pimple formation. You can meet a dermatologist for the guidance of taking the same.

Reduce your stress level too as high stress leads to hormonal up surge and thereby more eruption of pimples.

Hope these informations will help you.
If you have any further query I will be happy to help.

Regards,

Dr Sanjay Kumar Kanodia
MD (Dermatology & Sexually transmitted diseases)
Note: For further guidance on mental health, Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Sanjay Kumar Kanodia

Dermatologist

Practicing since :2002

Answered : 4165 Questions

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Suggest Treatment For Allergic Dermatitis Of Penile Area

Brief Answer: Kindly send details and pictures Detailed Answer: Hello XXXXXXX Welcome and thanks for posting your query to the forum. I have gone through your complete query and read all the concerns including each and every point related to your health query. I can make out that you are in great agony since more than last 5 months. I promise you that I will try to help you best regarding your problem. You have nicely elaborated your query so that I can presumptively think in one particular direction. But to help you best I request you to send good resolution pictures of the affected area. For that you have a feature to upload images by yourself at the right side of the query page. Or else, you can send as an attachment to YYYY@YYYY with the subject as "Attn: Dr. Sanjay Kumar Kanodia. Also kindly tell me certain important points: - other than redness have you ever felt any kind of discharge from the penile site. - Any history of sore formation or ulceration on the site. - Severity of itching and pain- mild/ moderate/severe/unbearable. - Any tests done in last 5 months and the results. I again reassure you that I will not leave any stone unturned to help you best regarding your problem. Hope to hear soon from your side. Wish you good health. Regards, Dr Sanjay Kumar Kanodia (MD- Dermatology & Sexually Transmitted Diseases)