Male Genital Dermatoses

Dr D'ippolito is the Lead Clinician of the Male Genital Dermatoses Clinic at Frimley Park Hospital.

Because of the variety of skin tissue types, a moist warm environment and a higher risk of infections associated with the urinary tract, the genital area tends to attract more than its fair share of dermatological problems. Only a few of these are associated with sexual activity, many are simply a common consequence of changes with ageing. However, a tendency to 'ignore and put off' discussing problems in the genital area with your GP means that otherwise minor dermatological issues often present only after they have had time to develop to the point where they can't be ignored.

Genital Psoriasis & Eczema

The causes and consequences are much the same as the condition appearing on other areas of the body, but itching and irritation in the genital area can be extremely irritating and embarrassing.

The most common type of psoriasis in the genital region is inverse psoriasis. This type of psoriasis first shows up as smooth, dry, red lesions which can appear in the creases around the buttocks or groin. It usually lacks the scale associated with plaque psoriasis.

Genital psoriasis can be difficult and frustrating to treat. However, it generally responds well to treatment. Due to the sensitivity of genital skin the aim is to achieve rapid symptomatic relief.

Eczema of the genital area is often – like eczema in other areas - a consequence of an allergic reaction to some substance coming into contact with the skin.

Lichen Sclerosus

Lichen sclerosus is a long-term skin condition that mainly affects the skin of the genitals. It usually causes itching and main visual sign is white patches typically appearing on the foreskin and end of the penis.

Other areas of the body are also occasionally affected, including the upper arms, back, breasts and shoulders.

It's not clear what causes lichen sclerosus, but it's thought to be related to overactivity of the immune system. Although uncomfortable and distressing, most cases respond to simple treatments.

Lichen Planus

Lichen planus is thought to affect 1-2% of the worldwide population. It's more common in adults over the age of 40.

Like lichen sclerosus, the causes are not well understood, but the symptoms are distinctive:

• purple or white ring-shaped patches on the tip of the penis (glans)
• bumps (papules) that are flat-topped and shiny
• a non-itchy rash

Effective treatment can be as simple as avoiding washing with soap or bubble bath – use plain warm water or a soap substitute instead, such as aqueous cream. Use of emollients as a barrier cream against whatever might be causing the skin irritation.

Flare-ups can be treated with topical corticosteroid creams and in a few more serious or intractable cases there are several effective immunomodulating agents.

Balanitis of Zoon

Zoon's balanitis is a chronic, quite rare and benign condition. It describes inflammation of the head of the penis (glans penis) and foreskin. It usually affects middle-aged to elderly men who have not been circumcised.

The word Balanitis is derived from the Greek word Balanos, which means 'acorn'. The ending '-itis' stands for inflammation. Balanitis means inflammation of the glans penis. The condition is named after Professor Zoon, a Dutch dermatologist, who described the condition in 1952. In addition to the glans penis, the foreskin is often involved. The cause is unknown, but there are a number of topical treatments that have proved to be effective.

Genital Warts

Genital warts are small fleshy growths, bumps or skin changes that appear on or around the genital or anal area.

Genital warts are the result of a viral skin infection caused by one of up to 30 different strains of human papilloma virus (HPV). Although they are infectious and can be passed on through sexual contact, they are usually painless and do not pose a serious threat to health.

The treatment for genital warts depends on how many warts you have and where they are. Several treatments are available, such as liquids or creams and freezing the warts (cryotherapy). Please note that you should NOT use wart creams that are available over the counter because they are designed to only treat warts on the hands or verrucas.

Genital Moles

Moles are a type of nevus, or a skin blemish that can be flat, raised slightly above the skin's surface, or on a stalk. They can be coloured or not coloured, and with or without hair growth. Moles are not usually present at birth but form and increase in number as you grow older. Most are harmless and do not require any treatment.

However if a nevus suddenly grows, changes colour, bleeds or shows any other signs of being unusual or changing, then it is important to have it checked.

For more information, please refer to our sections on mole mapping, melanoma and mole removal.

Thrush

Thrush is a yeast infection caused by a fungus called Candida albicans. Both men and women can get thrush, though it is more often associated with women. The medical term for thrush is candidiasis.

In men, it usually affects the head of the penis – causing irritation, discharge and redness.

If symptoms of Thrush in men include:

• irritation, burning or itching under the foreskin or on the tip of the penis
• redness, or red patches under the foreskin or on the tip of the penis
• a discharge under the foreskin that may look like cottage cheese
• difficulty pulling back the foreskin of your penis (phimosis)

If you recognise the symptoms, it is possible to treat thrush without prescription medications. For thrush affecting your penis, ask your chemist for clotrimazole cream or a tablet called fluconazole.

You can help prevent thrush by keeping your penis clean and dry. Infections are often 'shared' between sexual partners, so to avoid re-infection you and your partner may need to treat the infection.

Avoid using perfumed soaps or shower gels on your genitals, as they can cause irritation.

Wearing loose-fitting cotton underwear can help prevent moisture building up under your foreskin, which removes the conditions that micro-organism enjoys and lowers the chances of the candida fungus multiplying.