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Suggest Treatment For Eczema Of The Penis
Question: Hello. For the past two months, I have been dealing with what seems to be a stubborn case of eczema of the penis and perhaps another condition altogether. In full disclosure, I do have HPV II with limited outbreaks (two a year), so my doctor and I initially believed my rash like symptoms (no ulcers/sores) on the shaft of my penis was a mild HPV II outbreak. However, Famvir and Valtrex did not clear up the issue. We then attempted to treat the rash as a fungus and tried prescription topical creams (and oral medications) that seemed to make the rash much worse. I discontinued these products after ten days and applied an over-the-counter hyrdocortisone product that did seem to help a little. I returned to the doctor and was told I likely have eczema, and was prescribed a more powerful steroid ointment called Fluticasone Propionate. This has seemed to clear up most of the eczema on the shaft of the penis. However, there remains a redness near the head of the penis. On closer investigation, if I pull the penis skin tighter, I can see that what appears to be a rash in this area is in fact inflamed veins. They are red in color and seem to be grouped together tightly in a bundle, thus giving the appearance of a rash. There are not lumps or sores. I have limited sexual activity for the past few months which has not cleared up the issue. I have also discontinued putting the steroid ointment on the inflamed vein area and seen no improvement. Pictures attached. Please advise.
Brief Answer:
Thinning of skin due to steroid over use
Detailed Answer:
Hi
I understand your concern regarding your skin problem and I hope I am able to help you in the same .
I have seen the attached pictures .
Even on close inspection, I do not see any signs of eczema or any other infection over the genitals at present.
You might have developed some form of eczema over the shaft earlier and you have taking treatment for the same.
I would like to tell you that at present you have developed thinning of skin along with telangiectasia over the shaft of penis which you can see as grouped veins. Now such a thinning and appearance of veins over the shaft occurs due to prolonged use of topical steroids over the area.
So most importantly , you need to completely stop using all steroid creams. Also since there is no evidence of any eczema at present, so you do not need to apply any steroids . The skin over genitals is very thin and is very prone to side effects due to excess steroid use.
All you need to do right now is to clean the affected areas with warm saline water twice a day. Dry the area and apply an antifungal cream twice a day. The redness that you might just denote beginning of a fungal infection since such infections are common after prolonged use on steroid creams.
I am sure if you follow the above regimen for a week, your problem will get better.
Also since eczemas over the genitals are not very common, so the next time that you develop any lesions over the shaft, you should see a local dermatologist before starting application of any topical steroid creams.
Hope it helps
Please ask if you need any further clarifications
Dr Geetika Paul
Thinning of skin due to steroid over use
Detailed Answer:
Hi
I understand your concern regarding your skin problem and I hope I am able to help you in the same .
I have seen the attached pictures .
Even on close inspection, I do not see any signs of eczema or any other infection over the genitals at present.
You might have developed some form of eczema over the shaft earlier and you have taking treatment for the same.
I would like to tell you that at present you have developed thinning of skin along with telangiectasia over the shaft of penis which you can see as grouped veins. Now such a thinning and appearance of veins over the shaft occurs due to prolonged use of topical steroids over the area.
So most importantly , you need to completely stop using all steroid creams. Also since there is no evidence of any eczema at present, so you do not need to apply any steroids . The skin over genitals is very thin and is very prone to side effects due to excess steroid use.
All you need to do right now is to clean the affected areas with warm saline water twice a day. Dry the area and apply an antifungal cream twice a day. The redness that you might just denote beginning of a fungal infection since such infections are common after prolonged use on steroid creams.
I am sure if you follow the above regimen for a week, your problem will get better.
Also since eczemas over the genitals are not very common, so the next time that you develop any lesions over the shaft, you should see a local dermatologist before starting application of any topical steroid creams.
Hope it helps
Please ask if you need any further clarifications
Dr Geetika Paul
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Thank you, doctor. I have uploaded several new pictures to better demonstrate my condition. Picture "e" and "f" should help you see what appears to be eczema. You can also see the red vein issue near the head of the penis in these pictures and pictures "g" and "h".
I'm confused as to why you recommended I use fungal cream. As stated in my previous message, anti-fungal creams I tried made the rash symptoms much work. The doctor I saw was a dermatologist and she diagnosed the eczema when the anti-fungal creams failed. By the way, I have had eczema in the past, just not on the genitals.
Also, is there nothing that can be done to speed up the recovery of telangiectasia? I have discontinued putting the topical steroid on this area, but it seems to be taking awhile to heal.
The previous message should say "...anti-fungal creams I tried made the rash symptoms much worse."
These products were Ciclopirox Ointment Cream and Ketoconazole.
Thank you.
I'm confused as to why you recommended I use fungal cream. As stated in my previous message, anti-fungal creams I tried made the rash symptoms much work. The doctor I saw was a dermatologist and she diagnosed the eczema when the anti-fungal creams failed. By the way, I have had eczema in the past, just not on the genitals.
Also, is there nothing that can be done to speed up the recovery of telangiectasia? I have discontinued putting the topical steroid on this area, but it seems to be taking awhile to heal.
The previous message should say "...anti-fungal creams I tried made the rash symptoms much worse."
These products were Ciclopirox Ointment Cream and Ketoconazole.
Thank you.
Brief Answer:
Regular treatment , weaning off steroids
Detailed Answer:
Hi again
I have seen all the attached pictures . I have had a close look at the skin lesions.
The most important problem in your case is seemingly that of steroid induced damage to the skin.
There is definitely redness in certain areas along the penile shaft but that does not necessitate the use of topical steroid creams any longer.
It is very important for you to understand that the skin over the male genitals is very thin and is very prone to side effects of long term steroid use.
When one applies steroid creams to the skin for a long time, our skin tends to become dependent over the steroid cream. So when one stops it's application suddenly, the redness and irritation tends to increase as a rebound phenomenon .
Since you have developed skin redness atrophy and telangiectasia , I would suggest you to slowly wean your skin off steroids. This means that you can use a very mild topical steroid cream like cortisone over the affected areas once a day for two to three days. Then after this, you can apply this cream on alternate days for the next three to four days and then finally stop it's application . This way your skin will slowly get better and you will be able to get rid of steroid dependence.
Also I advised you to apply antifungals since long term use of steroids makes ones skin prone to fungal infections , so it is good to take a one week course of the same once you are completely off steroids. A mild fungal infection can also manifest with redness over the penile region .
Also the good thing is that your skin problem is not even that bad that you will need a long term treatment .
In fact you should avoid the use on steroids in future as much as possible .
Telangiectasia are basically prominent veins that become visible due to thinning of skin due to steroid overuse. As one gives up the use of steroids, the skin also slowly recovers from the side effects .
Dr Geetika Paul
Regular treatment , weaning off steroids
Detailed Answer:
Hi again
I have seen all the attached pictures . I have had a close look at the skin lesions.
The most important problem in your case is seemingly that of steroid induced damage to the skin.
There is definitely redness in certain areas along the penile shaft but that does not necessitate the use of topical steroid creams any longer.
It is very important for you to understand that the skin over the male genitals is very thin and is very prone to side effects of long term steroid use.
When one applies steroid creams to the skin for a long time, our skin tends to become dependent over the steroid cream. So when one stops it's application suddenly, the redness and irritation tends to increase as a rebound phenomenon .
Since you have developed skin redness atrophy and telangiectasia , I would suggest you to slowly wean your skin off steroids. This means that you can use a very mild topical steroid cream like cortisone over the affected areas once a day for two to three days. Then after this, you can apply this cream on alternate days for the next three to four days and then finally stop it's application . This way your skin will slowly get better and you will be able to get rid of steroid dependence.
Also I advised you to apply antifungals since long term use of steroids makes ones skin prone to fungal infections , so it is good to take a one week course of the same once you are completely off steroids. A mild fungal infection can also manifest with redness over the penile region .
Also the good thing is that your skin problem is not even that bad that you will need a long term treatment .
In fact you should avoid the use on steroids in future as much as possible .
Telangiectasia are basically prominent veins that become visible due to thinning of skin due to steroid overuse. As one gives up the use of steroids, the skin also slowly recovers from the side effects .
Dr Geetika Paul
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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