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Suggest treatment for balanitis

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Posted on Thu, 26 Nov 2015
Question: Please direct this question to Dr. XXXXXXX Hanif
I have been having discussion with him for balanitis problems. However the question was automatically closed after 3 answers
doctor
Answered by Dr. Muhammad Hanif (1 hour later)
Brief Answer:
Welcome back!!!

Detailed Answer:
Thanks for the consultation at my virtual clinic!
I have carefully worked through your case, and can well realize your health worries. Being your physician, I will take care all of your medical concerns today and will put my best efforts to get you out of this situation.


I am here to help. Give me detailed query please.

Hope I answered all of your questions. Let me know if you have further clinical concerns or doubts. I will be more than happy to get back to you with expert opinion. Please don't forget to give Five Star rating to help me assist my patients in a better way; and, please don't forget to 'Close This Discussion'.
For any disease you have, a timely follow-up is very necessary regarding the treatment efficacy and to see if there is a need to change the treatment options. So keep a follow up to see how you doing (Always write down my name in the start of your questions at this forum & I will be with you in no time).


Regards!
DR. XXXXXXX HANIF
USA

Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Muhammad Hanif (40 minutes later)
I have uploaded the latest picture Nov 10th. I noticed after applying all three ointments, the condition is getting worse instead of getting better, more red areas in the main patch. You can see more RED color compared to earlier images. There are 3-4 superficial ulcers, very small. The area around them is little red, there is NO PAIN anywhere. I also noticed the RED band area is still there. This BAND and NO PAIN, it's now 10 days since I started applying Neosporin,

Do you think it is not EQ or ZOON. That's my worry, it's obsessing my mind as I keep seeing this RED band demarcated pictures everywhere . Why the band still there.

CAN you provide me EXACT reason why you think this is not ZOON or EQ. A longer explanation would help me. I see three reason that are making me worry

1) RED band that is distinctly different than rest of the glans skin, the patch looks slightly raised than rest of the penis skin
2) smaller superficial ulcers
3) Not responding to anti fungal/anti biotech treatment as expected - Although I have no idea how long the treatment is needed since I never had balanitis before
4) Velvety dark red color - is ZOON, EQ - Bright red with sharp borders ? or it's of the color of my RED spots..? I am confused - I see different pictures saying different things

Do you think small ulcers are indications that this is not ZOON or EQ - in these there are no ulcers until very later stage where there is crusting etc - smooth RED bright band - velvety color


That's my main worry, nothing else. If this is just plain balanitis I don't think it will worry me that much.


How long will take this RED bad to fade away ?. If you compare with earlier 5 picture - PLEASE check them one by one sequentially. There is change everyday. Very strange. There were 2 ulcers a week ago, now I see small 4 ulcers. The band seems to be elevated from the rest of the glans skin. Now it looks lot red than earlier picture. The color changes everyday
I also noticed wen I apply COCONUT oil, the rash feels better. The redness is less. I am wondering if I should go non antibiotic- anti-antifugal - and use more natural medicine. Apply Vaseline and COCONUT oil which may help heal it better. The medicines are harsh and making it worse, may be some reaction and acutally creating more small ulcers. It looks more RED. May be this is not bacterial or fungal infection. It definitely looks worse every morning..

Please check the COCONUT OIL picture I have attached
Picture 1 and 2

what the heck is this rash ?
I just don't get it, very frustrating
It changes color all day..and everyday looks worse and then sometimes better

doctor
Answered by Dr. Muhammad Hanif (4 hours later)
Brief Answer:
It is the natural way the inflammatory processes show up!!!

Detailed Answer:
Welcome back and thanks for the consultation at my virtual clinic!


WHEN somebody gets a red inflammatory process anywhere on the skin???
Somebody gets inflammation and infection when there is a defeat to the defense mechanisms and the causative agent wins. It doesn't mean you have got an autoimmune disease. Autoimmune disease means body has started engulfing its own parts. Immune system fights against pathogens, and in autoimmune disease the system falsely thinks the body's own tissues to be like pathogens and starts fighting against them.

You have got the simple inflammation of the penile head and is not zoon. Now,why it changes color every day to show you up differently??
It is all natural and sometimes patient is misguided from the online given pictures and think as if it resembles to the same. The reality is different as everyone has got different etiologies and presentations. But if you see online frequently, there you will get a thousand diseases that you may think is same as looks like to be yours.

You have got some ulcers and that is also natural course of the disease. We may not say that it is an indicator of getting worse or better. Wait and see with an observance of more patience is the key to better results.


I was of the view to start Tacrolimus and potent antifungal but it was difficult for you to get a prescription due to some reason. Then we had to opt in for the OTC. When it comes to selection of medicines, we don't have to see what is available and have to choose. We have to focus on the bulls eye option sometimes to clearly knock the disease down. But it is also not a bad option that you are using right now. Only thing you need is some more patience. Balanitis may take weeks to heal properly. That's why I also added some Immunity booster foods for you for better and fast results.


When you apply coconut, the roughness goes away and the shine of skin glows and you feel it is better. It is not better due to just a single application of oil but actually seems better due to camouflage effect and there is loss of roughness of the debris.

The color of skin and the raised margins are also natural course of your disease and you have to again wait with patience. Don't make a guess so frequently please and give it proper time to heal up. Bets part of it is that you don't have any weeping and crusting skin, no bleeding is there. The ulcers you are talking about is denudation of the old inflamed skin and is actually in response to the new skin formation underneath and is a sign of convalescence and betterment.


If it has not been responding to the treatment you are taking, I must have reviewed that. It is going fine up til now.

Hope I answered all of your questions. Let me know if you have further clinical concerns or doubts. I will be more than happy to get back to you with expert opinion. Please don't forget to give Five Star rating to help me assist my patients in a better way; and, please don't forget to 'Close This Discussion'.
For any disease you have, a timely follow-up is very necessary regarding the treatment efficacy and to see if there is a need to change the treatment options. So keep a follow up to see how you doing (Always write down my name in the start of your questions at this forum & I will be with you in no time).


Regards!
DR. XXXXXXX HANIF
USA

Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Muhammad Hanif (2 hours later)
so you are absolutely sure this is not EQ or Zoon and it's just plain inflammation due to some irritation, trapped urine/semen/debris in the past that caused the defense mechanism to break down and allowed inflammation. The appearance of band scared me, now the small ulcers that are showing are tender to touch. I may have to assume this will continue for few weeks.

If this is not EQ or Zoon 100% - please say -YES, more than Zoon EQ is stuck in my head due to velvet feel and red color of that inflamed area, red band and lack of real pain in the symptoms. I know zoon is benign, but EQ is not..

The reason I have been thinking catastrophic and worse is because of Oral lichen planus that popped up in my mouth in last November and still on going, it's painful and I can't eat hot or spicy food that much. I have developed a fear that I have AUTOIMMUNE diseases on all my mucous membranes and they will all cause SCC

That's the root cause of all my worries - fear of SCC CANCER !

If this was plain balanitis - I would have forgotten by now -

It's that fear of EQ - that's all..

Last year I had burning in urine for 2 months everyday..I was not even bothered and then it went away...just like that. I hope this goes away like that too..

I have added 2 more pictures. I think the pictures will help you keep track if there is any improvement.

Appreciate your kindness and help. I hope I get over this. It's been painful past 10 days..I am depressed with these fears..

Thank you
doctor
Answered by Dr. Muhammad Hanif (20 minutes later)
Brief Answer:
You need a punch biopsy of the oral lesion for sure!!!

Detailed Answer:
Welcome back Mr. XXXX and thanks for the consultation at my virtual clinic!

First answer to assure you and to calm you down:-
YES It doesn't seem to be Zoon.

Ulcers always hurt. It is natural for touching and getting pain on an ulcer. It is rather good meaning that the nerves on the area are intact and giving response to touch and pain stimuli.


You definitely need to go for the Punch biopsy for the lesion in your mouth that is there for a year or so. Consult your local Physician for in office consultation and recommendations regarding that mouth lesion.


Thanks for the efforts in uploading the 5 pm pictures. I have reviewed and pretty much hopeful that it is going to be fine soon.

Please don't get depressed. Conditions like this take time and needs some more patience. I really appreciate your words of appreciation and I am always here to help you.


Hope I answered all of your questions. Let me know if you have further clinical concerns or doubts. I will be more than happy to get back to you with expert opinion. Please don't forget to give Five Star rating to help me assist my patients in a better way; and, please don't forget to 'Close This Discussion'.
For any disease you have, a timely follow-up is very necessary regarding the treatment efficacy and to see if there is a need to change the treatment options. So keep a follow up to see how you doing (Always write down my name in the start of your questions at this forum & I will be with you in no time).


Regards!
DR. XXXXXXX HANIF
USA

Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Muhammad Hanif (1 hour later)
A full Biopsy (almost 1 cm piece) was done in 2015 January for oral lichen planus, that where they found it was oral lichen planus. There is no ulcer, only reticular lines inside cheeks. Nothing on tongue, only two sides of cheeks. OLP I have researched a lot. I had shown the OLP to dentist( three months ago) and homeopath (last month), he feels it's ok for now.

why do you think there is need to do punch biopsy if the clinical signs are ok, no ulceration, reticular lines (in between there is some redness, on new lesions only). There was a time I could not brush teeth with regular tooth paste(crest). Now I can, it used to burn earlier. The only time it burns is when I eat spicy food, that happens with most OLP patients. Very rarely people are able to eat spicy food.

However in case of OLP I have taken hopemeopathic treatment. I have avoided tropical steroids completely. The old lesions that were painful early have subsided(redness), but new ones popped up. OLP lasts longer than skin lichen planus.

SCC is risk with OLP, but the I believe the chances are still very low. The homepoath has seen 2000 OLP patients and he feels mine is ok.

I know people with OLP should be under watch, but do you think biposy is needed every year ? if clinically there is no ulceration or anything. I am curious
I can send you pictures of OLP inside my cheeks tomorrow.

Could you please clarify ?. You create another worry for me :) with that biposy statement

Thanks
Here are the pictures of OLP, attached olp1, olp2, olp3
Interestingly there is almost 70% healing of reticular lines and you can see mucosa looks fine, in fact even reticular lines have almost disappeared, there is new OLP in upper side of the teeth, however old OLP has healed over 80% even white lines, there is some brown discoloration that happens after OLP burns out (hyperpigmentation)

There is no ulceration as of now, there is redness in new olp lesions that formed 3 months ago, only they are little red, hopefully then will burn out too. However old ones have healed almost 70-80%, there is no ulceration other than some redness in new old. However I am able to brush with Crest toothpaste are the signs, conditions have improved substantiallly
Clinically it's lot better than six months ago, barring new lesions that are formed in upper areas. However according to the doctor, the new will form and eventually they will run out of the course. The OLP may last 2 years like skin. The doctor have said clinically you need to see the signs, improvements and see if you can tolerate some food, if not all. However he also said burning pain is subjective and some people may tend to feel more burning. It's not clear why some people feel burning in OLP, higher sensitivity even with reticular lesions.

Please take a look and let me know. I appreciate your help. In fact the homepath said he has seen substantial improvement than earlier lesions which were not good

I have also attached 2015 lesions from January 2015 - when disease was just started..see please note the difference , the white lines have almost gone in recent

Thank you
doctor
Answered by Dr. Muhammad Hanif (57 minutes later)
Brief Answer:
You just mentioned about oral lesion; that's why I suggested biopsy!!!

Detailed Answer:
Welcome back and thanks for the consultation at my virtual clinic!

**you just mentioned about the oral lesions and I believed it to be Oral Lichen Planus. That's why I suggested to go for the biopsy.

((why do you think there is need to do punch biopsy if the clinical signs are ok, no ulceration, reticular lines (in between there is some redness, on new lesions only). There was a time I could not brush teeth with regular tooth paste(crest). Now I can, it used to burn earlier. The only time it burns is when I eat spicy food, that happens with most OLP patients. Very rarely people are able to eat spicy food.))

**I asked for bioipsy because lesions like you mentioned in your mouth and going so long are Oral lichen planus and I wanted you to confirm this diagnosis. Good to know you are already done with biopsy. Even if the lesions are OK looking, we still need to go for serial biopsy and testing advised by a Physician. Don't let it go like that--although less but chances are there for SCC in this way.


((SCC is risk with OLP, but the I believe the chances are still very low. The homepoath has seen 2000 OLP patients and he feels mine is ok.))
** I am not saying your Homeopath says wrong. But you still will need a yearly testing through laboratory.


((I know people with OLP should be under watch, but do you think biposy is needed every year ? if clinically there is no ulceration or anything. I am curious
I can send you pictures of OLP inside my cheeks tomorrow.))

**I will appreciate any pictures and will review for you. Yes even if no obvious signs of ulcers or serious disease, oral lichen planus needs follow up.



((Could you please clarify ?. You create another worry for me :) with that biposy statement))

**You just mentioned that there is an oral lesion too. I thought of Lichen and wanted to get my differential diagnosis confirmed through biopsy.


Regards!
DR. XXXXXXX HANIF
USA

Above answer was peer-reviewed by : Dr. Yogesh D
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Follow up: Dr. Muhammad Hanif (1 hour later)
Hi, I have provided some attachments. Please review them.
doctor
Answered by Dr. Muhammad Hanif (37 minutes later)
Brief Answer:
Yes I have Carefully gone through all of them!!!

Detailed Answer:
Welcome back Mr. XXXX!

I have received that query and have completely gone through all of your attached files and have given my detailed opinion on them. I hope you will soon receive that answer. I am at your disposal for any further help if needed for anything related to your health issues.



Hope I answered all of your questions. Let me know if you have further clinical concerns or doubts. I will be more than happy to get back to you with expert opinion. Please don't forget to give Five Star rating to help me assist my patients in a better way; and, please don't forget to 'Close This Discussion'.
For any disease you have, a timely follow-up is very necessary regarding the treatment efficacy and to see if there is a need to change the treatment options. So keep a follow up to see how you doing (Always write down my name in the start of your questions at this forum & I will be with you in no time).


Regards!
DR. XXXXXXX HANIF
USA

Above answer was peer-reviewed by : Dr. Sonia Raina
doctor
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Follow up: Dr. Muhammad Hanif (1 hour later)
Now you will notice the color of the RED patch is darker. I notice it is darker at night and becomes a proper band. This whole thing I hope is not EQ
Crazy changes all day in color and patches change. The patch that looked it's healing becomes complete RED at night , why ?
what could change it ? just like that ?

Please see attached picture Nov11-10 PM
doctor
Answered by Dr. Muhammad Hanif (56 minutes later)
Brief Answer:
It's how inflammatory processes go in a natural way of waxing and waning!!!

Detailed Answer:
Welcome back to HCM!


Yes I have reviewed your attached picture (Nov 11-10PM). Thanks for uploading it.

It is how the inflammatory processes go in a natural way of waxing and waning. That's why I was going to use the Tacrolimus. It was to reduce your inflammation fast but still it has had not been so fast as you are looking for. As I said this is not a disease of a day or two. It may take weeks (not specified) according the different health and disease status for every patient. As I already mentioned in the very start of our interaction that, anxiety also causes the inflammatory processes to get slower in healing. So patience is the key.

Hope I answered all of your questions. Let me know if you have further clinical concerns or doubts. I will be more than happy to get back to you with expert opinion. Please don't forget to give Five Star rating to help me assist my patients in a better way; and, please don't forget to 'Close This Discussion'.
For any disease you have, a timely follow-up is very necessary regarding the treatment efficacy and to see if there is a need to change the treatment options. So keep a follow up to see how you doing (Always write down my name in the start of your questions at this forum & I will be with you in no time).


Regards!
DR. XXXXXXX HANIF
USA

Above answer was peer-reviewed by : Dr. Prasad
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Dr. Muhammad Hanif

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Suggest treatment for balanitis

Brief Answer: Welcome back!!! Detailed Answer: Thanks for the consultation at my virtual clinic! I have carefully worked through your case, and can well realize your health worries. Being your physician, I will take care all of your medical concerns today and will put my best efforts to get you out of this situation. I am here to help. Give me detailed query please. Hope I answered all of your questions. Let me know if you have further clinical concerns or doubts. I will be more than happy to get back to you with expert opinion. Please don't forget to give Five Star rating to help me assist my patients in a better way; and, please don't forget to 'Close This Discussion'. For any disease you have, a timely follow-up is very necessary regarding the treatment efficacy and to see if there is a need to change the treatment options. So keep a follow up to see how you doing (Always write down my name in the start of your questions at this forum & I will be with you in no time). Regards! DR. XXXXXXX HANIF USA