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Are Itchy Red Rashes On The Testicle Skin At Night A Concern?
Question: 4 weeks ago I developed itching on the
Testicles skin at night for several nights . I used hot water to wash the area including penis . It felt comfort to do so . (Didnt take any medicine only hot water washing when I felt the urge of itching ) ...
Itching stopped .
2 weeks ago I got redness and irritation on the penis shaft . No itching . But painful specially when shaft is full (erection or going to bathroom for urination) , also painful when shaft retracts . All these symptoms are on the downside/lowerside of the the shaft . I used a cream called RESOLVE PLUS 2 times daily for 1 week . No progress . I visited doctor and was given 3 creams to mix together and apply on the shaft . Your opinion is highly appreciated . I have a photo I d like to send , so that you have a better understanding of what I am trying to describe , but I don't know how to send photo here . Please let me know
Testicles skin at night for several nights . I used hot water to wash the area including penis . It felt comfort to do so . (Didnt take any medicine only hot water washing when I felt the urge of itching ) ...
Itching stopped .
2 weeks ago I got redness and irritation on the penis shaft . No itching . But painful specially when shaft is full (erection or going to bathroom for urination) , also painful when shaft retracts . All these symptoms are on the downside/lowerside of the the shaft . I used a cream called RESOLVE PLUS 2 times daily for 1 week . No progress . I visited doctor and was given 3 creams to mix together and apply on the shaft . Your opinion is highly appreciated . I have a photo I d like to send , so that you have a better understanding of what I am trying to describe , but I don't know how to send photo here . Please let me know
Brief Answer:
Information
Detailed Answer:
Hello XXXX,
I was able to receive the photos you sent. The rash looks very angry and red, which would explain the pain you are having when the skin is stretched.
The RESOLVE PLUS contains miconazole which is an anti fungal and anti yeast medicine and hydrocortisone which is a mild steroid anti-inflammatory. The Elica-M you are using now also contains miconazole - the same anti fungal. If it has been several days since you started to use the combined cream and there has been no improvement, it's possible the rash, which is likely to be caused by either yeast or tinea (a fungus), is resistant to miconazole. It might be better at this point to switch to ketoconazole or clotrimazole which are both anti fungal/antiyeast.
I also think, if your doctor did not do this already, it would be a good idea to go back to the doctor and ask him to do a swab and send it for culture - both bacterial and fungal cultures. Because there is the possibility, given how red it is, that there is a bacterial infection such as staphylococcus. The fucidin has anti-staph activity, but if there is staph, it should not be used alone as bacterial resistance can happen quickly.
If it continues to get worse instead of better, you may need an oral anti fungal and possibly an oral antibiotic (depending on what the culture shows). Oral antifungals can be a bit hard on the liver as the medicine goes through your whole body so it isn't usually used as a first line medication if creams can do the job. Alcohol intake should not be done when taking an oral anti fungal (because of the effect on the liver).
If the rash has gotten worse since you started the creams, it is possible that you are having an allergic reaction to one of the creams, but I think this is less of a possibility as it would be very itchy.
As the rash is on the underside, there is likely to be skin to skin contact, which yeast and fungi thrive in. They like warm, dark, moist environments. If you don't already do so, wear cotton boxers and change if you get sweaty. After bathing/showering, XXXXXXX dry with tissue or a clean towel that you don't share, and then blow dry to get it even dryer, using a hair dryer on the very lowest setting. You don't want to burn the skin or irritate it with too much heat.
When sleeping, consider putting a thin cotton cloth or gauze between the underside of the penis and scrotum so that there isn't skin to skin contact. If the cloth moves out of place when you sleep, no worries, but it is something additional you can do.
If you have a sexual partner, they should be treated for yeast to make sure you are not passing this back and forth.
Do whatever you can to keep your immune system at full working power - adequate sleep, decreased stress if possible, good nutrition, avoidance of simple carbohydrates/excessive sweets.
Please let me know how things are going after you have been cultured, if you are willing.
Information
Detailed Answer:
Hello XXXX,
I was able to receive the photos you sent. The rash looks very angry and red, which would explain the pain you are having when the skin is stretched.
The RESOLVE PLUS contains miconazole which is an anti fungal and anti yeast medicine and hydrocortisone which is a mild steroid anti-inflammatory. The Elica-M you are using now also contains miconazole - the same anti fungal. If it has been several days since you started to use the combined cream and there has been no improvement, it's possible the rash, which is likely to be caused by either yeast or tinea (a fungus), is resistant to miconazole. It might be better at this point to switch to ketoconazole or clotrimazole which are both anti fungal/antiyeast.
I also think, if your doctor did not do this already, it would be a good idea to go back to the doctor and ask him to do a swab and send it for culture - both bacterial and fungal cultures. Because there is the possibility, given how red it is, that there is a bacterial infection such as staphylococcus. The fucidin has anti-staph activity, but if there is staph, it should not be used alone as bacterial resistance can happen quickly.
If it continues to get worse instead of better, you may need an oral anti fungal and possibly an oral antibiotic (depending on what the culture shows). Oral antifungals can be a bit hard on the liver as the medicine goes through your whole body so it isn't usually used as a first line medication if creams can do the job. Alcohol intake should not be done when taking an oral anti fungal (because of the effect on the liver).
If the rash has gotten worse since you started the creams, it is possible that you are having an allergic reaction to one of the creams, but I think this is less of a possibility as it would be very itchy.
As the rash is on the underside, there is likely to be skin to skin contact, which yeast and fungi thrive in. They like warm, dark, moist environments. If you don't already do so, wear cotton boxers and change if you get sweaty. After bathing/showering, XXXXXXX dry with tissue or a clean towel that you don't share, and then blow dry to get it even dryer, using a hair dryer on the very lowest setting. You don't want to burn the skin or irritate it with too much heat.
When sleeping, consider putting a thin cotton cloth or gauze between the underside of the penis and scrotum so that there isn't skin to skin contact. If the cloth moves out of place when you sleep, no worries, but it is something additional you can do.
If you have a sexual partner, they should be treated for yeast to make sure you are not passing this back and forth.
Do whatever you can to keep your immune system at full working power - adequate sleep, decreased stress if possible, good nutrition, avoidance of simple carbohydrates/excessive sweets.
Please let me know how things are going after you have been cultured, if you are willing.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
thank you so much for your detailed answer . I really appreciate it . just to conclude , from the photos I sent , you think it is fungal/bacteria infection , nothing more ?
I just started the application of (fucidin+Elica-M+Bepanthen ) mixture today and I was told to use it for a week . RESOLVE I used it one week ago with no use , so I stopped it yesterday . Your comments will be highly appreciated . Thanking you in advance
I just started the application of (fucidin+Elica-M+Bepanthen ) mixture today and I was told to use it for a week . RESOLVE I used it one week ago with no use , so I stopped it yesterday . Your comments will be highly appreciated . Thanking you in advance
Brief Answer:
Thoughts on this
Detailed Answer:
I do think this is most likely fungal or yeast. Second on my list would be staph bacterial infection but that is less likely if it is not spreading rapidly.
Other more remote possibilities are genital psoriasis, but you would typically have psoriasis in other parts of your body as well unless this is your first presentation. But it isn't absolutely characteristic for it. An advanced scabies or pubic lice rash can look a bit like this, but you would keep getting new sores as these bugs will keep biting and moving to new locations. Secondary syphilis can give a rash anywhere on the body, but you would have seen a primary ulcer type sore first sometime back. A blood test can test for this.
Since both the RESOLVE and the current treatment contain the same anti fungal and in the same strength (miconazole nitrate 2%), and a week of the RESOLVE PLUS made no noticeable improvement, I think it would be best to go with an entirely different anityeast/antifungal medicine.
So I think it still best to get cultures (swab and/or skin scrapings) and try a different antiyeast-antifungal.
Thoughts on this
Detailed Answer:
I do think this is most likely fungal or yeast. Second on my list would be staph bacterial infection but that is less likely if it is not spreading rapidly.
Other more remote possibilities are genital psoriasis, but you would typically have psoriasis in other parts of your body as well unless this is your first presentation. But it isn't absolutely characteristic for it. An advanced scabies or pubic lice rash can look a bit like this, but you would keep getting new sores as these bugs will keep biting and moving to new locations. Secondary syphilis can give a rash anywhere on the body, but you would have seen a primary ulcer type sore first sometime back. A blood test can test for this.
Since both the RESOLVE and the current treatment contain the same anti fungal and in the same strength (miconazole nitrate 2%), and a week of the RESOLVE PLUS made no noticeable improvement, I think it would be best to go with an entirely different anityeast/antifungal medicine.
So I think it still best to get cultures (swab and/or skin scrapings) and try a different antiyeast-antifungal.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Doctor ,
It has been several days since I started to use the combined cream (mentioned above )and there has been no improvement, so today I went to see a dermatology . After inspection , he confirmed that what I have is fungal infection and gave me the following :
1)Diflucan 150 mg capsule : take 2 capsules today and another 2 capsules after 1 week .
2)Travocort Cream : apply twice daily .
3) Lamisil Spray : spray once at night before applying Travocort.
I told him about the miconazole resistant that I might have .
I told him also we need a swab test but he said no need as he felt sure of his diagnose .
I requested an antibiotic , something like fucid cream , he also said no need at this point .
I took the 2 capsules of Diflucan already and applied the Travocort once since my morning visit to the dermatology .
I need your comment please on the above ?
Note :
Diflucan dosage above is enough ? Should not I be taken it daily instead of just 2 tablets a week ?
The cream and the spray, this time, is different than the miconazole ?
Your answer will be highly appreciated .
Thanking you in advance .
It has been several days since I started to use the combined cream (mentioned above )and there has been no improvement, so today I went to see a dermatology . After inspection , he confirmed that what I have is fungal infection and gave me the following :
1)Diflucan 150 mg capsule : take 2 capsules today and another 2 capsules after 1 week .
2)Travocort Cream : apply twice daily .
3) Lamisil Spray : spray once at night before applying Travocort.
I told him about the miconazole resistant that I might have .
I told him also we need a swab test but he said no need as he felt sure of his diagnose .
I requested an antibiotic , something like fucid cream , he also said no need at this point .
I took the 2 capsules of Diflucan already and applied the Travocort once since my morning visit to the dermatology .
I need your comment please on the above ?
Note :
Diflucan dosage above is enough ? Should not I be taken it daily instead of just 2 tablets a week ?
The cream and the spray, this time, is different than the miconazole ?
Your answer will be highly appreciated .
Thanking you in advance .
Brief Answer:
Thoughts on this
Detailed Answer:
Hello XXXX,
A few thoughts on this:
Terbinafine which is the active medication in Lamisil is a good anti fungal. It isn't as effective against yeast. But it should help if this is tinea cruris. It is not the same as miconazole.
Travacort contains isoconazole which has broad spectrum coverage against a wide range of fungi and yeast. It has excellent penetration. Travacort also contains a topical steroid which has antiinflammatory function.
Diflucan is fluconazole which works against yeast and fungi. This medication can be given the way the dermatologist suggested - dosed now and repeated in a week. It will take a few days to see it's effects. It's best not to take it daily because unlike the topical anti fungal and anti yeast medications, it goes through your whole system and is processed by your liver. So I usually try to keep the dosing of it to a minimum. But at this point, I think it is very reasonable to use an oral like this as you have a bad skin infection.
Fucidin cream seems to be used more in the middle eastern countries and XXXXXXX but not often in the US - we rely more on the antifungals alone. It didn't do the job before, so I'd cut it out of the regimen. Fucidin has some coverage for staph bacteria, but if you had an infection with staph, the infection would typically have progressed by now and you would have a very hot to the touch rash that spread and possibly a fever by now. Fungi and yeast tend to progress more slowly than bacteria like stapholococcus.
I think given the coverage of 3 antimycotic medications, including topical and oral, and all of them different from what you tried before, you have a very good chance of beating this thing.
Do continue to try to keep the area as dry as possible and do whatever you can to keep your immune system at maximum (good nutrition, sleep, decreased sugars, no alcohol).
Thoughts on this
Detailed Answer:
Hello XXXX,
A few thoughts on this:
Terbinafine which is the active medication in Lamisil is a good anti fungal. It isn't as effective against yeast. But it should help if this is tinea cruris. It is not the same as miconazole.
Travacort contains isoconazole which has broad spectrum coverage against a wide range of fungi and yeast. It has excellent penetration. Travacort also contains a topical steroid which has antiinflammatory function.
Diflucan is fluconazole which works against yeast and fungi. This medication can be given the way the dermatologist suggested - dosed now and repeated in a week. It will take a few days to see it's effects. It's best not to take it daily because unlike the topical anti fungal and anti yeast medications, it goes through your whole system and is processed by your liver. So I usually try to keep the dosing of it to a minimum. But at this point, I think it is very reasonable to use an oral like this as you have a bad skin infection.
Fucidin cream seems to be used more in the middle eastern countries and XXXXXXX but not often in the US - we rely more on the antifungals alone. It didn't do the job before, so I'd cut it out of the regimen. Fucidin has some coverage for staph bacteria, but if you had an infection with staph, the infection would typically have progressed by now and you would have a very hot to the touch rash that spread and possibly a fever by now. Fungi and yeast tend to progress more slowly than bacteria like stapholococcus.
I think given the coverage of 3 antimycotic medications, including topical and oral, and all of them different from what you tried before, you have a very good chance of beating this thing.
Do continue to try to keep the area as dry as possible and do whatever you can to keep your immune system at maximum (good nutrition, sleep, decreased sugars, no alcohol).
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you so much for your comments . I just wanna ask , God forbids , if this present medicines I am applying , don't work , is there any other thing I can do ?
Brief Answer:
Information
Detailed Answer:
Hello XXXX,
If the regimen you are using now does not work adequately then your doctor may have you take the oral Diflucan (fluconazole) once a week for a few additional weeks.
And, or instead of continued oral Diflucan, he may choose a 3rd line type of anti fungal/anticandidal (yeast) treatment as there are others to choose from.
For example Naftifine (an allylamine antifungal) 2% cream is considered a promising new treatment for hard-to-treat cutaneous candidal infections. Micafungin and Voriconazole are also possible treatments if nothing else works.
But it is very likely for the current regimen of 3 antidermatophyte medications to work.
If this infection does not go away by the end of the course of your current treatment though, I do recommend that you demand a swab of the most affected areas to make sure it isn't an anaerobic bacterial infection. Usually this type of infection has a discharge and a foul smell though. And as mentioned above about staph, that usually causes swelling, bright redness, and typically spreads and makes you sick over time (fever).
So go ahead with the regimen of 3 anti fungal/anti yeast meds, and if that doesn't do the trick OR if it starts to get noticeably worse, then go back in to be seen (and demand a culture).
Some other things to think about: if you have any skin rashes such as "athlete's foot" or nail fungal infections, be sure to treat these too so that you don't spread it back and forth. Also, your sexual partner should be treated. And underwear should be cotton, not synthetic materials because cotton allows better air exchange. Underwear should be loose fitting.
Information
Detailed Answer:
Hello XXXX,
If the regimen you are using now does not work adequately then your doctor may have you take the oral Diflucan (fluconazole) once a week for a few additional weeks.
And, or instead of continued oral Diflucan, he may choose a 3rd line type of anti fungal/anticandidal (yeast) treatment as there are others to choose from.
For example Naftifine (an allylamine antifungal) 2% cream is considered a promising new treatment for hard-to-treat cutaneous candidal infections. Micafungin and Voriconazole are also possible treatments if nothing else works.
But it is very likely for the current regimen of 3 antidermatophyte medications to work.
If this infection does not go away by the end of the course of your current treatment though, I do recommend that you demand a swab of the most affected areas to make sure it isn't an anaerobic bacterial infection. Usually this type of infection has a discharge and a foul smell though. And as mentioned above about staph, that usually causes swelling, bright redness, and typically spreads and makes you sick over time (fever).
So go ahead with the regimen of 3 anti fungal/anti yeast meds, and if that doesn't do the trick OR if it starts to get noticeably worse, then go back in to be seen (and demand a culture).
Some other things to think about: if you have any skin rashes such as "athlete's foot" or nail fungal infections, be sure to treat these too so that you don't spread it back and forth. Also, your sexual partner should be treated. And underwear should be cotton, not synthetic materials because cotton allows better air exchange. Underwear should be loose fitting.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Doctor ,
Once again , thank you so much for the very informative reply . I really appreciate your advise . Thank you for being so patient and so friendly with my enquires . Sorry for wasting much of your valuable time on my case .
1)- I have read about CLOTRIMAZOLE (canesten) . Do you think Canesten would be better/stronger than TRAVOCORT ? Or it is the same ? .
2)-Also the LAMISIL , the doctor gave me to spray once before I apply TRAVOCORT, caused unbearable burning feeling in the area I spray , till I apply the TRAVOCORT . So I couldn't use the spray . I just apply TRAVOCROT without spray . Does this burning feeling means anything that might help find out what is wrong with me ? .
3)- I have had a sexual relation with a female , ended more than two years ago (ended August 2015) . After that , and for the past years , I never had any health problem that might be linked to that relation . Do you think that , what I have now , might be the result of that old relation ? Or I am right in thinking that if this is STD/STI related to that old relation , it should have appeared earlier rather than just now ?
Thank you so much .
Once again , thank you so much for the very informative reply . I really appreciate your advise . Thank you for being so patient and so friendly with my enquires . Sorry for wasting much of your valuable time on my case .
1)- I have read about CLOTRIMAZOLE (canesten) . Do you think Canesten would be better/stronger than TRAVOCORT ? Or it is the same ? .
2)-Also the LAMISIL , the doctor gave me to spray once before I apply TRAVOCORT, caused unbearable burning feeling in the area I spray , till I apply the TRAVOCORT . So I couldn't use the spray . I just apply TRAVOCROT without spray . Does this burning feeling means anything that might help find out what is wrong with me ? .
3)- I have had a sexual relation with a female , ended more than two years ago (ended August 2015) . After that , and for the past years , I never had any health problem that might be linked to that relation . Do you think that , what I have now , might be the result of that old relation ? Or I am right in thinking that if this is STD/STI related to that old relation , it should have appeared earlier rather than just now ?
Thank you so much .
Brief Answer:
Information
Detailed Answer:
Hello XXXX,
No need for apologies. I have had other patients with rashes on their penis and it can be quite anxiety provoking when it doesn't go away. It's normal to be concerned about an ongoing health problem - it motivates us to take action and protect ourselves.
1. Clotrimazole is not what is in Travacort. Travacort has a steroid medication and it's anti fungal and anti yeast medication is isoconazole.
Isoconazole, clotrimazole, and miconazole are all in the same family of drugs called imadazoles.
I cannot find any studies comparing the statistical efficacy of clotrimazole with isoconazole for tinea cruris or candidal infection of the penis and scrotum (if yeast is on the head of the penis then it is call balanitis). Both usually work well.
Diflucan is in a different class called triazoles and the different classes have somewhat different mechanisms for disrupting fungi and yeast. So having both medications means that you are coming at the infection from 2 different angles, which is helpful.
2. I wouldn't worry too much about not being able to use the Lamisil. If the infection is yeast, the Lamisil isn't that effective - it is mostly for fungal infections. Diflucan and Travacort treat both. There may be something in the spray that you are reacting to such as a preservative or other agent. But you don't want to cause more inflammation so if you can't use it, that is ok. Lamisil does come as a powder, so you might want to call the dermatologist's office and tell him about the burning from the spray. If he still thinks it's important for you to use Lamisil, he may prescribe the powder.
3. Regarding the relations with the woman 2 years ago, that would not cause yeast or fungal infections now. The things that can present later are syphilis (and this does not look like a secondary syphilitic rash), and HIV (and you have not had any other more typical primary symptoms of HIV that you have described).
Do you have any other health problems, such as frequent infections, diabetes, obesity, or anything else? Are you taking any other medications?
---------------------
I'm including below an abstract from a medical journal that you might find useful, about Travacort:
Mycoses. 2013 May;56 Suppl 1:3-15. doi: 10.1111/myc.12054.
Isoconazole nitrate: a unique broad-spectrum antimicrobial azole effective in the treatment of dermatomycoses, both as monotherapy and in combination with corticosteroids.
Veraldi S.
Abstract
Fungal skin infections, or dermatomycoses, are associated with a broad range of pathogens. Involvement of gram-positive bacteria is often suspected in dermatomycoses. Inflammation plays an important role in dermatomycoses, displaying a close association between frequent inflammation and reduced skin-related quality of life. Isoconazole nitrate (ISN) is a broad-spectrum antimicrobial agent with a highly effective antimycotic and gram-positive antibacterial activity, a rapid rate of absorption and low systemic exposure potential. ISN is effective against pathogens involved in dermatomycoses, with minimum inhibitory concentrations well below the concentration of ISN in skin and hair follicles. The combination of the corticosteroid diflucortolone valerate with ISN (Travocort) increases the local bioavailability of ISN. Compared with ISN monotherapy, Travocort has a faster onset of antimycotic action, faster relief of itch and other inflammatory symptoms, improved overall therapeutic benefits and earlier mycological cure rate. Travocort is effective in the treatment of inflammatory mycotic infections, and also in the eradication of accompanied gram-positive bacterial infections. The rapid improvement observed with Travocort treatment, combined with favourable safety and tolerability, results in higher patient satisfaction, and therefore, can be an effective tool to increase treatment adherence in patients with dermatomycoses accompanied by inflammatory signs and symptoms.
Information
Detailed Answer:
Hello XXXX,
No need for apologies. I have had other patients with rashes on their penis and it can be quite anxiety provoking when it doesn't go away. It's normal to be concerned about an ongoing health problem - it motivates us to take action and protect ourselves.
1. Clotrimazole is not what is in Travacort. Travacort has a steroid medication and it's anti fungal and anti yeast medication is isoconazole.
Isoconazole, clotrimazole, and miconazole are all in the same family of drugs called imadazoles.
I cannot find any studies comparing the statistical efficacy of clotrimazole with isoconazole for tinea cruris or candidal infection of the penis and scrotum (if yeast is on the head of the penis then it is call balanitis). Both usually work well.
Diflucan is in a different class called triazoles and the different classes have somewhat different mechanisms for disrupting fungi and yeast. So having both medications means that you are coming at the infection from 2 different angles, which is helpful.
2. I wouldn't worry too much about not being able to use the Lamisil. If the infection is yeast, the Lamisil isn't that effective - it is mostly for fungal infections. Diflucan and Travacort treat both. There may be something in the spray that you are reacting to such as a preservative or other agent. But you don't want to cause more inflammation so if you can't use it, that is ok. Lamisil does come as a powder, so you might want to call the dermatologist's office and tell him about the burning from the spray. If he still thinks it's important for you to use Lamisil, he may prescribe the powder.
3. Regarding the relations with the woman 2 years ago, that would not cause yeast or fungal infections now. The things that can present later are syphilis (and this does not look like a secondary syphilitic rash), and HIV (and you have not had any other more typical primary symptoms of HIV that you have described).
Do you have any other health problems, such as frequent infections, diabetes, obesity, or anything else? Are you taking any other medications?
---------------------
I'm including below an abstract from a medical journal that you might find useful, about Travacort:
Mycoses. 2013 May;56 Suppl 1:3-15. doi: 10.1111/myc.12054.
Isoconazole nitrate: a unique broad-spectrum antimicrobial azole effective in the treatment of dermatomycoses, both as monotherapy and in combination with corticosteroids.
Veraldi S.
Abstract
Fungal skin infections, or dermatomycoses, are associated with a broad range of pathogens. Involvement of gram-positive bacteria is often suspected in dermatomycoses. Inflammation plays an important role in dermatomycoses, displaying a close association between frequent inflammation and reduced skin-related quality of life. Isoconazole nitrate (ISN) is a broad-spectrum antimicrobial agent with a highly effective antimycotic and gram-positive antibacterial activity, a rapid rate of absorption and low systemic exposure potential. ISN is effective against pathogens involved in dermatomycoses, with minimum inhibitory concentrations well below the concentration of ISN in skin and hair follicles. The combination of the corticosteroid diflucortolone valerate with ISN (Travocort) increases the local bioavailability of ISN. Compared with ISN monotherapy, Travocort has a faster onset of antimycotic action, faster relief of itch and other inflammatory symptoms, improved overall therapeutic benefits and earlier mycological cure rate. Travocort is effective in the treatment of inflammatory mycotic infections, and also in the eradication of accompanied gram-positive bacterial infections. The rapid improvement observed with Travocort treatment, combined with favourable safety and tolerability, results in higher patient satisfaction, and therefore, can be an effective tool to increase treatment adherence in patients with dermatomycoses accompanied by inflammatory signs and symptoms.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Doctor ,
Thank you so much for your kind reply . Yesterday , I went to the lab and did some tests . Blood , Urine and swab .
Urine culture(bacteria & fungus) will be ready in 5 days . Swab (dry & gel ) will be ready in 2 weeks .
I have posted some results I got today for your kind preview . They seem ok . So I think syphilis and chlamidya are out of discussion . (Happy to know that ) .
I don't have any other symptoms rather than this penile rash . In fact I never had any problem in the past 5 years with anything .
I am taking Co-diovan 160/12.5 as I have high blood pressure for the past 15 years and I think it is controlled .
Also , I am obese , but it is not something new . I have been like this all my life .
No diabetic
I would appreciate your thoughts on the above . Please have a look at the test results attached .
Thank you so much for your patient .
Thank you so much for your kind reply . Yesterday , I went to the lab and did some tests . Blood , Urine and swab .
Urine culture(bacteria & fungus) will be ready in 5 days . Swab (dry & gel ) will be ready in 2 weeks .
I have posted some results I got today for your kind preview . They seem ok . So I think syphilis and chlamidya are out of discussion . (Happy to know that ) .
I don't have any other symptoms rather than this penile rash . In fact I never had any problem in the past 5 years with anything .
I am taking Co-diovan 160/12.5 as I have high blood pressure for the past 15 years and I think it is controlled .
Also , I am obese , but it is not something new . I have been like this all my life .
No diabetic
I would appreciate your thoughts on the above . Please have a look at the test results attached .
Thank you so much for your patient .
Brief Answer:
Thoughts on your labs
Detailed Answer:
I am glad you do not have diabetes as that can delay or complicate healing.
So from your labs so far we can see that you do not have syphilis (negative RPR) or chlamydia as you know.
I am very glad that you got swabs done for culture.
Taking a look at the urinalysis:
It looks essentially normal. The "slight hazy" is probably due to the presence of mucus. I am not sure how this particular lab quantifies mucus by I am guess that 1+ is minor, as opposed to 3+ (+++). It can also be that they report it is either + or nil without quantifying but it would be more common to quantify it. Mucus is not a variable reported routinely by all labs. Mucus in the urine can be from may different things, and if there is any irritation of the urethra, then the body will produce mucus which will show up when the urine passes through and is collected in the urinalysis. This would be particularly true if a swab of the urethra was done prior to sending you to collect the urine specimen as this would create some temporary irritation. So without other noticeable abnormalities (and in particular, the number or white blood cells is low as it should be), I would not make much of the presence of mucus in the urinalysis.
In the US, our reference range for rbc (red blood cells) is less than or equal to 3 rbcs per high power field. The results of yours probably falls into this range (3-5) which may be this lab's standard way of reporting rbcs. For example they may report it as zero, or 1-2, or 3-5, or higher than 5. So it may be that you have 3 rbcs, which would be within a normal range on US urinalysis lab references.
Thoughts on your labs
Detailed Answer:
I am glad you do not have diabetes as that can delay or complicate healing.
So from your labs so far we can see that you do not have syphilis (negative RPR) or chlamydia as you know.
I am very glad that you got swabs done for culture.
Taking a look at the urinalysis:
It looks essentially normal. The "slight hazy" is probably due to the presence of mucus. I am not sure how this particular lab quantifies mucus by I am guess that 1+ is minor, as opposed to 3+ (+++). It can also be that they report it is either + or nil without quantifying but it would be more common to quantify it. Mucus is not a variable reported routinely by all labs. Mucus in the urine can be from may different things, and if there is any irritation of the urethra, then the body will produce mucus which will show up when the urine passes through and is collected in the urinalysis. This would be particularly true if a swab of the urethra was done prior to sending you to collect the urine specimen as this would create some temporary irritation. So without other noticeable abnormalities (and in particular, the number or white blood cells is low as it should be), I would not make much of the presence of mucus in the urinalysis.
In the US, our reference range for rbc (red blood cells) is less than or equal to 3 rbcs per high power field. The results of yours probably falls into this range (3-5) which may be this lab's standard way of reporting rbcs. For example they may report it as zero, or 1-2, or 3-5, or higher than 5. So it may be that you have 3 rbcs, which would be within a normal range on US urinalysis lab references.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you so much . I 'll contact your goodself once more results are available .
Brief Answer:
Your welcome - hope you are better soon.
Detailed Answer:
I'll await hearing from you. Please be sure to continue with the Travacort and the once a week Diflucan in the meantime. Hopefully you will start to see some improvement soon. - B. Berger-Durnbaugh MD
Your welcome - hope you are better soon.
Detailed Answer:
I'll await hearing from you. Please be sure to continue with the Travacort and the once a week Diflucan in the meantime. Hopefully you will start to see some improvement soon. - B. Berger-Durnbaugh MD
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Doctor ,
Today , I got 2 more results , as per attached reports . I think they are ok ? . Fungus results need 3 more weeks to be available .
Today , I got 2 more results , as per attached reports . I think they are ok ? . Fungus results need 3 more weeks to be available .
Brief Answer:
Questions
Detailed Answer:
I took a look -
The urine culture is normal - no urinary tract infection.
The other culture from a swab, I have two questions about:
1. Was the swab taken inside the urethra or from the rash site for the report that identified klebsiella? Do you remember where they swabbed for this (side of penis? scrotum?)?
2. The lab didn't write how many bacteria (usually an estimate) and so there might only be a few klebsiella bacteria in which case it may be just a skin contaminate especially if it was on the scrotum. Is it possible to call the lab to get more information about this? Also, they may be able to tell you what site the swab for this was taken from.
Are you using the 2 medications and are you seeing any signs of improvement?
Is there any foul odor or pus from the rash?
Questions
Detailed Answer:
I took a look -
The urine culture is normal - no urinary tract infection.
The other culture from a swab, I have two questions about:
1. Was the swab taken inside the urethra or from the rash site for the report that identified klebsiella? Do you remember where they swabbed for this (side of penis? scrotum?)?
2. The lab didn't write how many bacteria (usually an estimate) and so there might only be a few klebsiella bacteria in which case it may be just a skin contaminate especially if it was on the scrotum. Is it possible to call the lab to get more information about this? Also, they may be able to tell you what site the swab for this was taken from.
Are you using the 2 medications and are you seeing any signs of improvement?
Is there any foul odor or pus from the rash?
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Doctor ,
Thank you so much for your reply . the swab was taken from the rash area under the penis shaft. Regarding klebsiella lab told me it is very few and don't need medication . Still I am using the 2 medication , 1 week now, and I can't feel any progress . I also start to have very sensitive head of penis opening . when urinating , if leftover droplets touch this area I get burning feeling . I wash with water , it then becomes ok . (Balatania infection ) .
at this stage , at least , we are sure it is fungus infection , right ? not STD nor bacteria . Sadly , fungus culture and swab needs 3 weeks .
Thank you so much for your reply . the swab was taken from the rash area under the penis shaft. Regarding klebsiella lab told me it is very few and don't need medication . Still I am using the 2 medication , 1 week now, and I can't feel any progress . I also start to have very sensitive head of penis opening . when urinating , if leftover droplets touch this area I get burning feeling . I wash with water , it then becomes ok . (Balatania infection ) .
at this stage , at least , we are sure it is fungus infection , right ? not STD nor bacteria . Sadly , fungus culture and swab needs 3 weeks .
Brief Answer:
Thoughts on this
Detailed Answer:
Well, the swab culture would have shown if there was staphylococcus or streptococcus. If there were very few klebsiella then it probably isn't from that either. We also now know that there is no chlamydia or syphilis.
The most likely cause is still yeast or fungi. We can't say with 100% certainty, but it looks like a yeast or fungal rash, and it is the most common cause, and we aren't seeing any large bacterial growth on the culture.
I'm going to suggest 2 options:
1. Wait a couple more days, and if absolutely no signs of improvement (it can take up to a couple of weeks), then go back to the dermatologist to have him take another look in person.
2. Go now and switch to another anti yeast/antifungal such as clotrimazole or other agents.
I don't know how long it takes to get an appointment with a dermatologist where you live. Here it can take awhile. So you might want to call now for an appointment and then you can cancel if you see there is some improvement.
The irritation around the urethra can be from yeast spreading to the head of the penis or it can be from irritation from the cream. But if it gets any worse, go in to be seen.
It's possible that you might get a "preliminary report" on the fungal culture sooner than the 3 weeks (hopefully). It's also possible, if the medications are treating the fungi or yeast already, since you were on these meds when you got the swab done, that the culture comes up negative, but likely there will be some present.
Thoughts on this
Detailed Answer:
Well, the swab culture would have shown if there was staphylococcus or streptococcus. If there were very few klebsiella then it probably isn't from that either. We also now know that there is no chlamydia or syphilis.
The most likely cause is still yeast or fungi. We can't say with 100% certainty, but it looks like a yeast or fungal rash, and it is the most common cause, and we aren't seeing any large bacterial growth on the culture.
I'm going to suggest 2 options:
1. Wait a couple more days, and if absolutely no signs of improvement (it can take up to a couple of weeks), then go back to the dermatologist to have him take another look in person.
2. Go now and switch to another anti yeast/antifungal such as clotrimazole or other agents.
I don't know how long it takes to get an appointment with a dermatologist where you live. Here it can take awhile. So you might want to call now for an appointment and then you can cancel if you see there is some improvement.
The irritation around the urethra can be from yeast spreading to the head of the penis or it can be from irritation from the cream. But if it gets any worse, go in to be seen.
It's possible that you might get a "preliminary report" on the fungal culture sooner than the 3 weeks (hopefully). It's also possible, if the medications are treating the fungi or yeast already, since you were on these meds when you got the swab done, that the culture comes up negative, but likely there will be some present.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Doctor ,
Today I visited the dermatologist . I told him that there was no progress . He inspected the rash area and told me there was progress and that Travocort would need more time to work .
I told him about other anti-fungal cream (Naftfine) , he said Travocort is stronger .
I insisted on getting something better . I told him about Canesten and that I want to use it .
He finally told me to mix Travcort with Canesten twice daily . Also to take 2 oral tablets of 150 mg Diflucan.
He also gave me something called Ave Cicalfate Cream , for building skin I think . He asked me to see him after 1 week .
Despite this dermatologist is one of the best here , and despite he seems very confident of what he is saying/doing , I didn't get much progress so far . Today he didn't like me doing all the lab test as he consider his eye inspection is the best and enough . I told him I need to do any lab test in the world to have peace of mind not to continue wasting time while there might be a major issue within . He couldn't say a word when I answered him this way .
So to summarize , I 'll be applying mixture of Canesten & Travcort Twice Daily and separately twice applying Ave Cicalfate , in addition to , two tablets of Duflican tonight .
Don't you think the mixture of Canesten & Travort will be a good idea ?
Your thoughts on the above will be highly appreciated .
I am sorry for bothering you this much , with my case . I really trust your opinion that is why I turn to you .
Thanking you in advance
Today I visited the dermatologist . I told him that there was no progress . He inspected the rash area and told me there was progress and that Travocort would need more time to work .
I told him about other anti-fungal cream (Naftfine) , he said Travocort is stronger .
I insisted on getting something better . I told him about Canesten and that I want to use it .
He finally told me to mix Travcort with Canesten twice daily . Also to take 2 oral tablets of 150 mg Diflucan.
He also gave me something called Ave Cicalfate Cream , for building skin I think . He asked me to see him after 1 week .
Despite this dermatologist is one of the best here , and despite he seems very confident of what he is saying/doing , I didn't get much progress so far . Today he didn't like me doing all the lab test as he consider his eye inspection is the best and enough . I told him I need to do any lab test in the world to have peace of mind not to continue wasting time while there might be a major issue within . He couldn't say a word when I answered him this way .
So to summarize , I 'll be applying mixture of Canesten & Travcort Twice Daily and separately twice applying Ave Cicalfate , in addition to , two tablets of Duflican tonight .
Don't you think the mixture of Canesten & Travort will be a good idea ?
Your thoughts on the above will be highly appreciated .
I am sorry for bothering you this much , with my case . I really trust your opinion that is why I turn to you .
Thanking you in advance
Brief Answer:
Information
Detailed Answer:
Hello -
Sorry that the dermatologist was offended. We doctors all have our egos (well all people do) but you as a patient do need to look out for your well being.
Combining Canesten (clotrimazole) with Travacort is fine and will address the infection broadly.
The Cicalfate contains zinc and copper and helps with skin healing.
About the Diflucan (fluconazole): In the literature that is available to me in the US, I can't find specific recommendations for taking 300 mg (in other words 2 of the 150 mg) of fluconazole, but it's possible that dermatologists use it this way and it is not alarming. The literature here recommends 150 mg once a week for 2-6 weeks for tinea cruris ("jock itch" rash) or 1 dose of 150 mg for yeast balanitis. For women with severe vaginal yeast infections that are recurrent, there is recommendation that the 150 mg dose be repeated 72 hrs apart for a total of 2-3 doses. So there is variation but this gives you a range.
The 300 mg dose is large but Diflucan can be given in high dosages. If you haven't taken it yet, you can try 1 (150 mg) tonight and 1 in 3 days.
No worries about bothering me. But please know that while I have seen these infections as a family medicine doctor, I am not a dermatologist, so the doctor you are seeing's advice is likely to be good.
Information
Detailed Answer:
Hello -
Sorry that the dermatologist was offended. We doctors all have our egos (well all people do) but you as a patient do need to look out for your well being.
Combining Canesten (clotrimazole) with Travacort is fine and will address the infection broadly.
The Cicalfate contains zinc and copper and helps with skin healing.
About the Diflucan (fluconazole): In the literature that is available to me in the US, I can't find specific recommendations for taking 300 mg (in other words 2 of the 150 mg) of fluconazole, but it's possible that dermatologists use it this way and it is not alarming. The literature here recommends 150 mg once a week for 2-6 weeks for tinea cruris ("jock itch" rash) or 1 dose of 150 mg for yeast balanitis. For women with severe vaginal yeast infections that are recurrent, there is recommendation that the 150 mg dose be repeated 72 hrs apart for a total of 2-3 doses. So there is variation but this gives you a range.
The 300 mg dose is large but Diflucan can be given in high dosages. If you haven't taken it yet, you can try 1 (150 mg) tonight and 1 in 3 days.
No worries about bothering me. But please know that while I have seen these infections as a family medicine doctor, I am not a dermatologist, so the doctor you are seeing's advice is likely to be good.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you so much doctor . I do understand that you are trying to help as much as possible , even though you are not a dermatologist , and I am very pleased with all your guidance and suggestion and also I really appreciate it, so thank you .
I am going to use the mix of Travcort & Canesten for a week and if no progress again , I 'll be seeing another dermatologist rather than this present one who thinks he is class of his own .
1) Doctor ! if all these different antifungal cream doesn't work , is it possible that my case is inflammatory eczema and not related to fungus ? in that case I should be taken tacrolimus cream instead ?
2) How about using the natural remedy : yogut ? I eat yogut with food , but I don't know if it is a good idea to use it as a cream ?
(for 1 & 2 I just googled the net and read stories of people with similar symptoms )
Your comments will be highly appreciated .
I am going to use the mix of Travcort & Canesten for a week and if no progress again , I 'll be seeing another dermatologist rather than this present one who thinks he is class of his own .
1) Doctor ! if all these different antifungal cream doesn't work , is it possible that my case is inflammatory eczema and not related to fungus ? in that case I should be taken tacrolimus cream instead ?
2) How about using the natural remedy : yogut ? I eat yogut with food , but I don't know if it is a good idea to use it as a cream ?
(for 1 & 2 I just googled the net and read stories of people with similar symptoms )
Your comments will be highly appreciated .
Brief Answer:
Thoughts on this
Detailed Answer:
I looked for research articles on using yogurt on the skin and could only find information on using it intervaginally which is similar, but not entirely the same because in the case of putting it on penile skin it would be exposed to air. (And you don't want to occlude the skin of the penis because yeast and fungi really like to grow where it is dark, warm, and moist.) What you found on the internet - did it discuss using it on skin? If so, can you please send me the link?
Here is some information on do-it-yourself treatment for candida from University of Maryland. The website won't "link" here but you can copy and paste it in your address bar to see it:
http://www.umm.edu/health/medical/altmed/condition/candidiasis
Regarding inflammatory eczema: Sometimes the term eczema is used to mean dermatitis (inflammation of the skin) which is caused by many things. If you mean eczema in the medical sense (atopic dermatitis), this doesn't usually happen in a person who has no allergies or asthma. People with allergic predispositions are usually who get atopic dermatitis (eczema). Eczema is extremely itchy and typically produces a scaly rash. Over time the skin gets hyper pigmented.
If you are significantly overweight, if you have not had your blood sugar checked in recent months, that is a consideration. I am thinking this because if overweight, there is increased risk of diabetes type 2, and in that case your sugars may need to be controlled well to get over a fungal or yeast infection.
I do agree that if there is no improvement that you can see, none at all after 2 weeks of using the anti fungal/antiyeast medications that it would be a good idea to go to a different dermatologist for another opinion.
Thoughts on this
Detailed Answer:
I looked for research articles on using yogurt on the skin and could only find information on using it intervaginally which is similar, but not entirely the same because in the case of putting it on penile skin it would be exposed to air. (And you don't want to occlude the skin of the penis because yeast and fungi really like to grow where it is dark, warm, and moist.) What you found on the internet - did it discuss using it on skin? If so, can you please send me the link?
Here is some information on do-it-yourself treatment for candida from University of Maryland. The website won't "link" here but you can copy and paste it in your address bar to see it:
http://www.umm.edu/health/medical/altmed/condition/candidiasis
Regarding inflammatory eczema: Sometimes the term eczema is used to mean dermatitis (inflammation of the skin) which is caused by many things. If you mean eczema in the medical sense (atopic dermatitis), this doesn't usually happen in a person who has no allergies or asthma. People with allergic predispositions are usually who get atopic dermatitis (eczema). Eczema is extremely itchy and typically produces a scaly rash. Over time the skin gets hyper pigmented.
If you are significantly overweight, if you have not had your blood sugar checked in recent months, that is a consideration. I am thinking this because if overweight, there is increased risk of diabetes type 2, and in that case your sugars may need to be controlled well to get over a fungal or yeast infection.
I do agree that if there is no improvement that you can see, none at all after 2 weeks of using the anti fungal/antiyeast medications that it would be a good idea to go to a different dermatologist for another opinion.
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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