Managing Persistent Red Rash on Glans After Steroid Cream Withdrawal

The issue of the glans rash has worsened after discontinuing the use of corticosteroid ointment?

Hello Dr.
Lee,
Last month, my partner visited the clinic for a candidiasis issue, and I noticed many small red spots on my glans.
I promptly went to the hospital for a consultation and was prescribed medication.
I was treated with Meconazole ointment along with Cravit 500mg for 7 days.
After completing the treatment cycle, the red spots on my glans had almost completely disappeared.
Upon my follow-up visit, the doctor confirmed that there were no significant lesions and advised me to stop the medication.
I continued to apply Meconazole ointment and stopped after two days.
However, two days after discontinuing the medication, a red rash quickly appeared on the posterior part of my glans.
Within a day or two, the rash progressed to a more severe inflammatory state, causing pain and discharge.

I then sought medical attention again, but due to work constraints, I visited a family medicine clinic this time.
I was treated with Gentaderm cream, but after two days of treatment, I noticed that the area of redness had increased, and another rash had developed nearby, accompanied by discharge and pain.

I would like to ask the doctor what would be the best course of action for me at this point.
Should I stop the medication immediately, or would it be more appropriate to schedule another consultation? I would like to mention that during my regular hygiene routine, I use warm water to clean the glans while retracting the foreskin, and I do not use any cleaning products excessively.
Thank you.

Tim, 20~29 year old female. Ask Date: 2016/10/09

Dr. Li Xinyi reply Urology

Your cleaning seems to be done well.
Remember to dry it thoroughly; it could be herpes.
If it is herpes, the use of Meikang ointment is not recommended, nor is GENTADERM CREAM.
However, for a detailed assessment, it is advisable to return for a follow-up appointment to have the doctor confirm the situation.

Reply Date: 2016/10/09

More Info

Managing a persistent red rash on the glans after steroid cream withdrawal can be quite challenging, especially when previous treatments have shown some effectiveness but the symptoms recur. Based on the information provided, it appears that you initially responded well to the treatment with the topical steroid cream (美康藥膏) and the oral antibiotic (Cravit). However, after discontinuing the steroid cream, you experienced a resurgence of symptoms, including redness, inflammation, pain, and discharge.

The recurrence of symptoms after stopping the steroid treatment could be attributed to several factors. First, topical steroids can sometimes mask underlying conditions, such as fungal infections or dermatitis, which may flare up once the steroid is withdrawn. In your case, the initial treatment was for a candidal infection (yeast infection), and it is possible that the underlying infection was not fully resolved, leading to a return of symptoms.

The use of Gentaderm cream, which is likely a combination of gentamicin (an antibiotic) and a topical steroid, may not be appropriate if the underlying issue is a fungal infection, as antibiotics can exacerbate fungal growth. The increase in redness and the appearance of new lesions suggest that the current treatment may not be effective and could potentially be worsening the condition.

Here are some recommendations for managing your situation:
1. Stop Using Gentaderm Cream: Given that you have noticed an increase in symptoms after starting this cream, it would be prudent to discontinue its use. Continuing to apply a treatment that seems to be causing more irritation could lead to further complications.

2. Consult a Healthcare Professional: It is essential to seek medical advice from a healthcare provider, preferably a dermatologist or a urologist, who can assess your condition accurately. They may recommend a different treatment approach, such as antifungal medications if a yeast infection is suspected, or other topical treatments that do not contain steroids.

3. Maintain Good Hygiene: Continue to practice good hygiene by gently washing the area with warm water. Avoid using harsh soaps or cleansers, as these can irritate the sensitive skin of the glans.
4. Avoid Irritants: Be cautious with any products you apply to the area, including lotions or creams that may contain fragrances or other irritants. Stick to hypoallergenic products if necessary.

5. Monitor Symptoms: Keep track of any changes in your symptoms, including the size and appearance of the rash, pain levels, and any discharge. This information will be helpful for your healthcare provider in determining the next steps.

6. Consider a Patch Test: If you suspect that you may have developed a sensitivity or allergy to any topical treatments, a patch test conducted by a dermatologist can help identify potential allergens.

In summary, the recurrence of your symptoms after steroid withdrawal suggests that there may be an underlying condition that needs to be addressed. Discontinuing the current treatment and consulting a healthcare professional for a thorough evaluation and appropriate management is the best course of action. Remember, self-diagnosing and treating can sometimes lead to complications, so professional guidance is crucial in managing skin conditions effectively.

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