Dear Skin Doctor

Embarrassing rash like patches on both sides of penis. They appear as small red blotches that itch and sometimes skin flakes off in patches. No ulcers or broken skin.

Also the area below these patches the foreskin is also red, irritated and itchy.

Circumcised male, no sexual activity.

Thought it may have been a yeast infection but no cure has worked yet. Garlic, miconazole, diflucan, organic coconut oil have all failed to work.

Dear Patient

Your symptoms are suggestive of Penis Psoriasis

The diagnosis of Penis Psoriasis can be confirmed by having a skin biopsy done. In this procedure the doctor numbs the area with local anesthesia and cuts a small piece of skin which is sent to the laboratory to be examined under the microscope.

A KOH skin prep can also be done to rule out a fungal/yeast infection. In this painless procedure the skin is gently scraped with a blade and the scrappings sent to the lab where they are mixed with potassium hydroxide (KOH) and examined under a microscope for fungal elements.

 

Penis Psoriasis Treatment

After the diagnosis has been confirmed, the treatment of penis psoriasis includes:

1. Bland emollients like Vaseline petroleum jelly should be applied to reduce skin irritation.

 

2. Weak or moderate potency corticosteroid creams like Hydrocortisone cream can be applied sparingly since they can cause thinning of the skin.

 

3. Vitamin D analogues like Calcipotriol cream can also be used alone or in combination with steroid creams. They are usually the second line treatment.

 

4. Mild coal tar preparations can be used when treatment with weak topical steroids is not effective. The tar preparation can be mixed with a corticosteroid cream to reduce irritation.

 

5. Immunomodulators like the Calcineurin inhibitors Tacrolimus 0.1% applied twice a day for 10 days has been used to treat genital psoriasis successfully. Pimecrolimus has also been used for this condition. Though they do not thin the skin like topical steroids, they can cause a burning sensation and reactivate sexually transmitted infections like herpes and warts.

 

6. Dapsone has also been used effectively to treat genital psoriasis in some patients.