What causes a white patch at the tip of the penis?
Sometime back I had developed a small white patch on my penis tip. It was non-itchy and i could only see it while cleaning the penis tip during bathing.
I ignored it for sometime assuming it will go away, as such it was painless and non-itchy.
Few days later I had developed an tight ring on the penis foreskin and some portions of the skin (the tight ring) is having similar white patch. The skin in this area has become hard and rough. Due to this I can't pull back my foreskin while fully erected. If I pull it back then it cracks at several places and becomes painful.
Before this condition, I use to freely pullback the foreskin while fully erect and never faced any issue.
After reading about this type of conditions on internet, I thought it is fungal infection and started using an anti-fungal cream (Clotrimazole cream) for about two weeks.
But i don't see much of improvement. Can you please advise if I am taking the right medicine and if not what should I do.
Need more information and Images
Hello. Thank you for writing to us
I am dr. kakkar (dermatologist). I have gone through your query and I have noted your concern.
I would keep a possibility of either Candidal Balanoposthitis Or Balanitis Xerotica obliterans.
I request you to kindly upload an Image so that I am able to guide you better. You may upload an Image in "Reports Section".
Also let me know whether are you sexually active? If yes, did this condition start after sexual contact? and does your sexual partner also complain of vaginal discharge or vulval itching?
I have uploaded few pictures of the problem. Hope this will be useful in diagnosing.
Yes, I am sexually active. But can't exactly say that this happened after any sexual contact. as there was no pain and no itching, i didn't notice it post any specific activity.
The first time when I saw the white patch on the tip was when I was taking bath (I think i didn't have sex for about 2 months before the day I noticed it).
The foreskin issue i only noticed when the foreskin started tearing during masturbation or sex.
At this point it is difficult to assign this to any particular day of sexual contact.
My partner has never complained about such issue. She also is not aware of any such condition with her. Of course there is no vaginal discharge but but sometimes she tell about itching (not continuous but occasional).
Thank you. I have reviewed the Images.
I can see white atrophic patches on glans and undersurface of prepuce and I can make out tight foreskin. This is actually Balanitis Xeroticxs Obliterans Or Lichen Sclerosis et atrophicus (LSeA) rather than fungal infection.
Genital LSeA typically presents with dry and atrophic white patches of genital mucosa and in males it may lead to phimosis i.e difficulty retracting prepuce which may be severe enough to require circumcision.
Topical steroids are an established mode of treatment for genital LSeA. I suggest you to apply a topical moderately potent steroid cream e.g mometsone furoate 0.1% cream(Elocon cream), twice daily for 2-4 weeks.
Can you please answer my following queries -
1. What could be reason for this disease?
2. Is there any other medicine I can take orally along with this cream to help speedy recovery?
3. Is this treatment result in permanent cure or it may relapse?
4. If not treated properly, it can lead to what? I read somewhere that it can be pre-cancerous and lead to cancer, Is that true and possible with what probability? Shall I see a doctor physically?
5. Is it sexually transmissible? Shall I stop having sex with my partner?
6. Anything else should I know?
I am waiting for an answer to my above questions.
I apologize for some delay in my reply.
LSeA is an immunologically mediated condition. Its etiology is not clear.
In addition to topical treatment oral medications which belong to immunosuppressive category e.g mycophenolate mofetil, azathioprine, cyclosporine etc have been tried in LSeA.
LSeA is a self limiting condition in most patients i.e it arrests on its own but it may leave behind sequelae e.g phimosis in males and vaginal dryness and dyspareunia in females. Therefore treatment should be timely and appropriate. There may be relapses Or fluctuations in disease activity which can be managed accordingly.
LSeA may transform into cancer in a smalk number of patients; squamous cell carcinoma may arise from LSeA after years in a few patients(less than 5% of patients with genital LSeA), therefore any growth or bleeding lesion or ulcer within LSeA should be biopsied. Patients should be counselled about it so that they self examine and reports back in such instances.
It is not transmittable sexually. You may have sex with your partner however sex may cause discomfort. Yes, you should visit a dermatologist physically and follow up regularly.
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