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Long term red and 'thin' looking foreskin
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scandinave posted:
I'm a 32 y/o with a long term problem with the inside of my foreskin, and to a somewhat lesser degree also the glans.

The main day to day problem is that this area is clearly redder than it used to, and it will often have an uneven, almost bruised look to it. The redness covers a couple of inches below the head if I pull the foreskin all the way back, and affects it all the way around. It's not just redness, there are also a lot of bloodvessels showing through the skin, that were not (or only barely) visible before, these can be very blue and seem to be very close to the skin, they can stand out in relief in a way I had never seen before. These things to me make it seem as if the skin in this area has been thinned somehow, at least it looks that way to my non-medically trained eyes. It has been like this for at least 19 months, and I've seen no improvement. The glans is also affected in the sense that it can seem a little red and irritated, but often it can look pretty normal. There's no oozing, itching etc, although sometimes the skin can seem slightly more sensitive than normal. The redness can from lighter (quasi normal looking) to more serious from hour to hour, I assume this because of natural changes in blood flow etc.

The other part of the problem is that I occationally will get what I'll call 'flare-ups'. These are blotches of very red darker areas that appear on certain parts of the foreskin and often cover most of the glans. The skin in these areas will be more sensitive and slightly uncomfortable to touch, and the foreskin can also feel slightly swollen. This will usually clear up pretty quickly, within a day or two, and it will go back to what I reluctantly call 'normal'. It varies how often these occur, and at least once I didn't experience it for almost 5 months.

The whole thing started with this part of the foreskin suddenly looking sort of strange, greyish and slightly 'bumpy'. This happened after two or three very lazy days hygiene-wise, which I'm assuming is what caused it. I tried Canesten for a few days before going to the doctor. I believe it was around this time that it settled into this permanent redness instead. My doctor didn't even look at it, but since I had already tried Canesten he gave me Daktacort (with 1% hydrocortisone). I used this for about 9 days without any result. He then sent me to a dermatologist, who didn't think it looked that bad. He said I had balanitis, and that the skin just needed to heal. He agreed with the use of Daktacort, in fact he thought I could have used it for longer, but at present there was no need to do anything special about it. I'm skeptical of steroids, so using it more wasn't tempthing. I was careful to wash more with mild soap, 'air dry' more etc. After months of no improvement, and the occational flare-up, I went back to him. He started to use the word eczema, and seemed to think it was the flare-ups that kept the skin from healing. This time he gave me Protopic, which I applied twice a day for six weeks. This did nothing, and when I went back to him, he just said "Sorry, there's no cure for eczema yet', and basically just told me to keep it clean and hope for the best. This was about 7 or 8 months ago and it's the last time I've talked to any medical professional about it.

I have tried a bunch of different tips I've found online, stuff like high quality moisturizers, coconut oil, soaking in salt water etc. I don't want to go into that too much now, because many of these I have not tried consistently for a long time, so I can't really say I have 'proven' that they have no effect. However, putting something on, seems to make it less likely that a flare-up will happen. If there's any pattern to the flare-ups, it's seems to be that the more I leave me penis alone, the more likely it is that they will happen..

I would really appreaciate some thoughts or tips around what's going on with me.
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counterso responded:
You most likely either have a persistent candida problem, or you have a skin fungus. The first can be handled OTC in a week (plus your sex partner needs to be treated at the same time). If you see improvement, this was the issue. If no improvement, move on to the skin fungus probability and see a dermatologist (not a urologist) and get the appropriate treatment for the kind of skin fungus it is.

That the earlier treatments didn't work shows how little a regular doctor knows about penises (about as much as how a bowling ball is made).

I'm very surprised that the dermatologist did not identify it as a fungus to start, especially when the suggested treatment was ineffective.

Additionally, boost your own immune system by cutting out red meat, refined sugar, and caffeine (and smoking if you do) for a week and you'll probably notice a difference.
 
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scandinave replied to counterso's response:
Thank you!

That's interesting. I had almost excluded this possibilty, since both of the first things that I tried targeted this sort of thing (Dactakort also has 2% clotrimazole) and the dermatologist specifically stated that I did not have fungus (or at least that it didn't look like it). I'm trying Canesten again for a week now, it seems like the standard OTC option for this sort of this. To be honest, I'm having trouble separating yeast and other fungus type things, at least as far as OTC treatment goes, but I'll just give Canesten another try, a few more days this time, and see how it goes.
 
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counterso replied to scandinave's response:
There are many different kinds of fungi, and not all of them are as easily identified. Persisted discoloration in one of three colors without skin tears is more likely fungus. If there is tearing and thinning, or cracking of skin, it is more likely the candida variety, which can either be spontaneous due to weak immune system and poor diet, or as transferred from a sexual partner.

The first type of fungus can live much more deeply below the skin surface and is often more complicated to treat. Standard OTC applications do not usually resolve this type of fungus.

It is also possible that you have developed an allergy to a fabric, laundry detergent, or something else.
 
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scandinave replied to counterso's response:
Well, unsurprisingly Canesten didn't help. My plan was to try at least 10 days this time, but it seemed to irritate if anything, so I chose to stop after 8 days. I'm assuming I would have seen at least the slightest sign of improvement after 8 days if this treatment is something that would help me. It says 'apply a thin layer', maybe I'm applying it even more thinly than they mean..? I've also noticed it made the skin a more dry and a little 'leathery' to the touch..

It's strange, because whatever condition I search for online, basically none of the pictures look like what I have. The closest I've come was photos in an exchange someone had on one of those "pay for a doctor's answer online" sites. The doctor thought he had 'hypersensitive genital skin', and recommended moisturizers, beta caroten capsules, and OTC allergy pills, but admitted there isn't really any definite treatment for it.

I'm also afraid the cream with hydrocortisone that I used could have worsened and prolonged the problem. I've seen many stories online with people saying doctors ruined them seemingly for life with their belief that putting steroids on a penis is a good idea. However, it's hard to remember exactly how things developd back then, and that cream certainly didn't start the problem with redness..
When it comes to the immune system thing, I already eat little to no sugar, seldom eat red meat, and I don't smoke. Although cutting out coffee for a while wouldn't be a big problem, I feel like it's time to have someone actually look at at it again.
So, I guess the next step is to find another dermatologist. I'll probably go outside the public system this time, which means it'll be fairly expensive. I'm pretty anxious about it, since if I won't get any real help there either, I'll feel like I wasted all that money, and that I'll just have to reconcile with the fact that it will be like this probably forever. (Can you tell I'm pessimistic?) At the end of the day, I think it's worth a try, though. I guess I just have to seriously get it into the doctor's head that I'm there to really get to the bottom of things.
 
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counterso replied to scandinave's response:
Hydrocortisone is not safe to put on your genitals. Most dermatologist visits are going to be under $200, and they will give you an estimate of costs BEFORE you come in for your appointment if you explain your situation and ask them to give you an estimate.

Most OTC fungal creams are general application and can cause leathery skin, as well as be ineffective against deep fungal infections. Many times it requires an oral dosing or other prescription.

Sorry I can't assess it further, but have the conversation with the dermatologist's office by phone to see if they even think they can be helpful before you go spending money with one that never looks at such things on penises.
 
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scandinave replied to counterso's response:
Thank you,

It's going to be more than $200, but I live in a very expensive country. It's not that it's some giant sum of money, I'm just on a tight budget this month. It'll be easier and quicker than to try and get my regular doctor to send me to another dermatologist within the public system. I have already made an appointment with a doctor who at least to me seemed very knowledgeable an accomplished, from reading about her research, holding lectures etc. I don't know if this is common everywhere, but where I live, dermatologists are usually (or always) listed as specialists in venereal diseases, too, so she can't be that clueless about penises I think.. I have a few days to reconsider the appointment, but I'm thinking of just going for it.
 
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counterso replied to scandinave's response:
Call the doctor's office where you have the appointment and discuss your reason for coming before you arrive, to make sure they can be of help before you spend money.
 
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scandinave replied to counterso's response:
I had my appointment with the dermatologist today. (I also did call in advance, and simply put, they didn't see any reason why she wouldn't be the right doctor to see.)

Overall I'm quasi-happy with the visit, I felt like I was taken seriously and we did talk for quite a while. Although how fruitful it was remains to be seen, of course, and I'm not overly optimistic about actually solving the issue based on it. (Maybe I could get some help from the placebo effect I was )

She did not reach any specific diagnosis, but I expected that. 'Nonspecific balanitis' is basically like saying 'there's inflamation on your penis, and we don't know why', but she was open about this. What she kept coming back to was a sort of eczema-like irritation. She didn't suspect any yeast/fungus, and she didn't agree with my own hunch that the skin is 'permantently' damaged somehow, in the sense that it seems 'thinned'. So I'm sort of happy about that at least. Rather she thought the visible capillaries etc, are just part of the irritation.

My descriptions of the flare ups made her think of Zoon's balanitis, but she said the way they came and went so quickly didn't really fit that, and after googling pictures it doesn't quite look right to me, either.

She didn't take any biopsy at this point, but she did give me a little plan to follow. The reason I'm not that optimistic is that all of this sounds very close to things I have already tried.

1. Wash less often with soap, at most every other day instead of every day.
2. Despite my concerns about steroids, she wanted me to try a weak cortisone cream for 3 or 4 days (Apolar). I'll probably just do it, especially for such a short time.
3. Use a hair dryer so that the area becomes completely dry before applying anything. (I don't have one, so I'll either get a cheap one, or just be very careful to air dry for a good amount of time.)
4. One or two specific OTC creams/ointments that in her experience were often effective in calming irritation, but in different ways (one is more oily and 'fat', the other is more 'drying', with zinc), she didn't know which one would be best for me. I guess I'll try one for about week and then the other, if there's no improvement.

I'll just follow it for a while and then consider wether to see her again (for a biopsy maybe), or give up and just try to live with it.
 
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counterso replied to scandinave's response:
Apolar is an anti-itch steroid combined with neomycin, particularly for cases where scratching might lead to infection by bacteria or fungus. She's aware of the concerns and has picked something short term for you to try.

I'm glad she had a long conversation and took you seriously.

Don't give up. Report back to her by telephone in a week and let her know how things went. She will have new recommendations regardless.
 
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scandinave replied to counterso's response:
Thank you,

Well, the Apolar either did nothing or aggrevated ever so slightly, not sure. So far none of the two other creams seem to have any effect. To be honest, she seemed to think of them more in terms of prevention/maintenance after the steroid, so when that did nothing, maybe there's no reason to expect anything from them either.

I guess the last resort is to do a biopsy? I'm a little unsure of this, because I feel like I'm just throwing more money at something without having much faith in it, I don't expect it to lead to anything useful. I'm also bit apprehensive about any complications like a permanent mark, difficult healing process or something. It's hard to find much information about this sort of thing online. I don't think I can just call the doctor directly to get more help like that, I'll probably have to get another appointment. Although, hopefully I can reach her or someone else there (it's a big medical center with lots of departments etc) and ask if a new appointment, a biposy etc is something that she thinks is useful, after all it does cost a bit of money. I think I can remember her sort of thinking out loud about a biopsy, but landing on trying these other things first.
 
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scandinave replied to scandinave's response:
A little update:

I had a new appointment with the doctor today. When 'the plan' hadn't improved anything, she didn't seem to have much too add, but wanted to send me to a clinic that specializes in std's and so on. Not because she thought I were infected, but because genital skin is basically all they look at. This is under the public system so it will be cheap, and since I'm going there through her, I won't have to wait as long for an appointment. She still thought it looked like some sort of irritation, but also thought that in this case, it was strange that the Apolar didn't do anything.

I was more or less mentally prepared to do a biopsy, as I felt this appointment was probably going to be my last attempt to get to the bottom of things. We talked about it a little, and although I sort of felt that she gently leaned towards letting a doctor at that clinic look at it and let he/she decide wether a biopsy was necessary, it was up to me, and I went for it. As I was laying there I had a little moment of almost regret, wondering if this was a little bit drastic, as it would probably leave a permanent mark etc. But I also felt that paying for just having her send me somewhere else was annoying, and that having a third doctor just look at it probably won't going to lead anywhere. The procedure was mildly unpleasant for a few seconds total.

I just took off the little band aid and right now it looks like a little crater with a dot of dark dried blood in the middle. I don't expect the skin to ever look like as if nothing has happened there, but hopefully the scar will be nice and fairly unnoticable somewhere down the line. I'll probably get the results in a couple of weeks and she will send them to the clinic as well.
 
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maverick40 replied to scandinave's response:
Hi. This is quite amazing. I have exactly the same symptoms and have been searching high and low for answers for a very long time. As you said there are not even pictures on the net that look the same. May I ask if you have fair and sensitive skin as well? Please keep us updated on what the biopsy found. Hopefully there is a positive outcome to what you are going through. Hope so for us both. Thank you for sharing and all the best.
 
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scandinave replied to maverick40's response:
Thanks for your interest. I'm sorry to hear you're dealing with the same(?) thing. Do you really have the same 'story'?
Well, here's what's been happening since the last time I wrote here:
The biopsy didn't show anything wrong, although apparently they found some slight 'thickening of the skin', which surprised me, because it's the exact opposite of what I've always thought it looked like. (And of course I forgot to push the doctor on what this could mean, if anything. It didn't seem like it was an interesting find to them, though.) I never expected much help from the biopsy, it was more of a mental thing of having tried 'everything'. The scar is already more or less unnoticable, it depends on how the light hits it and mostly wether I'm actively looking for it.

The appointment with the last doctor at the std clinic was sort of interesting. She was very open and talkative, but didn't really see anything wrong. To her it all looked normal at this stage, and wouldn't start any sort of treatment. When I pointed to the pronounced increase in visible little veins and so on, she just said that sort of thing happens and pointed to how her hands were more veiny than when she was younger. Of course, the thing with me is that the change was so sudden. Although I can sort see how other people might think it looks normal (there's a lot of variety out there, I guess), it doesn't look normal to me because it's not how it was up until now. And of course, the two other doctors that looked at it didn't think it was quite 'nothing'. They all saw different versions of it though, since the redness varies all the time. She did comment that the glans looked a little dry, and explained to me how even the right kind of soap slowly peels away tiny layers of the skin or maybe it was some other sort of barrier. I had noticed the increased dryness myself, and for a period before that I washed twice a day with soap, so she was probably correct. From then I decided to stop using soap almost completely and instead wash twice a day with just water, thinking that maybe over a long period of time, it could have a positive effect in general. This fixed the dry glans pretty quickly, but if there's any change otherwise, it's too subtle for me to say for sure. Partly because of the results of the biopsy and what the last doctor said, I'm now just trying to move on. I've given up on hoping to "fix it", and try to see it for what it is, a problem that is mostly 'aesthetic' anyway, and often probably doesn' really look that bad either. If I'm to accept that there's nothing wrong with the skin on a regular basis, I'm wondering if it's all just down to an increase in vascularity, which was caused by an infection or something which is now gone. I don't know if it this is how it works, just trying to use my layman logic. There's still the question of the 'flare-ups', though. The last ones I've had are milder, but they keep reminding me that something isn't quite right (and maybe there's some sort of clue there). The description I gave seemed to leave the two last doctors scratching their heads, and they needed to see it for themselves. When I told the last doctor that they seem to happen if I e.g. had to skip the morning shower for some reason, she said that it such a minor thing shouldn't matter. To me it still seems like I have some sort of bacterial hypersensitivity.. If that's a thing? The last doctor gave me her card, so maybe if I get a bad flare up, I can get a quick appointment. To answer your question about my skin in general; I'm pretty pale most of the year, but I don't have what I believe is sometimes called "English type skin". I don't tan very easily, but I do tan. I also get red and flaky skin on my face if I don't moisturize every day (sometimes even if I do), and I pretty routinely get dry and itchy scalp. There's some more serious eczema etc in my family.
 
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scandinave replied to scandinave's response:
Hm, sorry about the 'wall of text'. It had plenty of spaces when I posted it.


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