Persistent Balanitis After Drug Allergy: Causes and Solutions

Post-drug allergy, balanitis may not resolve?

Hello, Doctor.
The problem began in May of last year when I experienced a sore throat and visited a doctor who prescribed anti-inflammatory medication.
After taking the medication for two days, I developed balanitis about a week later (symptoms of an allergy to the anti-inflammatory medication.
When allergic reactions occur, they manifest on more sensitive mucous membranes such as the oral cavity, the inner foreskin, and the anal area, leading to gradual skin breakdown and ulceration.
About 20 minutes after taking the medication, I started to feel itching at the tip of the foreskin and the anal area).
From June 1 to June 15, 2014, the initial phase of the balanitis presented with several red spots on the glans, and urination became painful.
After applying medication, the issue resolved.
Due to the drug allergy, I was hesitant to take antibiotics and anti-inflammatory drugs.
From June 16 to July 31, I experienced two symptoms: Symptom 1: I noticed that when the glans was exposed for a short period, the entire epidermis would appear dry and white, but it would return to normal once the foreskin covered it again.
However, upon exposure, the dryness would reoccur.
Symptom 2: About once every one to two weeks, I would experience inflammation on the glans, with red areas measuring approximately 0.5 cm, varying from 1 to 4 spots.
Applying Betamethasone improved the condition.
From July 31, 2014, to March 2015, Symptom 1: The dryness of the epidermis worsened.
Previously, it was a white, dry appearance, but during this period, the dryness became thicker and darker.
The color of the glans, when first exposed, no longer appeared pink.
Symptom 2: The inflammation frequency changed from once a month to suddenly occurring every 4-5 days starting in February 2015.
During this time, I applied zinc oxide for about two days, which helped the red patches disappear.
From March 2015 to now, due to the increased frequency of inflammation, I continued to see doctors.
During this period, I took antibiotics for two weeks and antifungal medication for two weeks, along with Betamethasone and Clotrimazole, applying them continuously for a month without effect.
I also tried Clotrimazole and zinc oxide for two months without improvement.
Recently, my doctor prescribed a triple-action ointment (zinc oxide + Clotrimazole + Gentian Violet).
After applying it for a week, I developed a new symptom: a dark, allergic reaction resembling a half-circle along the area where the foreskin meets the penis, parallel to the coronal sulcus, with signs of skin breakdown.
I noticed this while showering when I felt itching.
Additionally, in the past month, I have also experienced dryness on the outer side of the foreskin, sometimes even flaking skin over the entire foreskin.
This phenomenon only occurs on the upper part of the foreskin, while the area beneath it, adjacent to the scrotum, remains unaffected.
Applying Betamethasone improves this condition.
During this period, I underwent a urinalysis, and the doctor indicated the presence of fungi and Chlamydia, along with a Trichomonas test.
My white blood cell count was normal.
I would like to ask the doctor: 1.
After trying various medications without improvement, is there any way to identify the underlying issue? 2.
Among the medications I am currently using, which ones might have concerns regarding side effects? I worry that if the situation does not improve and I have to keep applying medication, could that lead to problems? 3.
With persistent inflammation symptoms, if there is no improvement, is the only option to continue applying medication? PS.
During this time, I have consistently consulted a specific teaching hospital's doctor, in addition to various doctors from other hospitals.
I have seen about six doctors, but I have only followed the prescriptions from the teaching hospital's doctor.
However, no doctor has been able to provide a clear explanation.
It is frustrating that a minor case of balanitis remains unresolved, yet the doctors seem to treat it as a trivial issue.

Fan Ren, 40~49 year old female. Ask Date: 2015/09/13

Dr. Xu Weikai reply Urology

Hello, based on your description, I cannot determine what factors may be causing your condition.
I am concerned about the possibility of misdiagnosis and therefore cannot provide any recommendations.
After all, you have already been treated by six different physicians.
If there are any unclear aspects, feel free to ask again, and we can discuss and research further.
Responses on the internet should only be considered as references; if necessary, it is still important to seek medical care at a healthcare facility.
The Ministry of Health and Welfare Taitung Hospital cares about you.

Reply Date: 2015/09/13

More Info

Persistent balanitis, especially following a drug allergy, can be a challenging condition to manage. Your symptoms, which began after taking anti-inflammatory medication, suggest a possible allergic reaction that has led to ongoing inflammation and irritation of the glans and surrounding areas. Here’s a comprehensive understanding of the situation, potential causes, and solutions.

Causes of Persistent Balanitis
1. Allergic Reaction: The initial allergic response to the anti-inflammatory medication may have triggered a hypersensitivity reaction. This can lead to inflammation of the glans (balanitis) and the surrounding skin, which may persist even after the offending drug is discontinued.

2. Irritation: Continuous exposure to irritants, such as soaps, detergents, or even certain fabrics, can exacerbate the condition. Maintaining proper hygiene is essential, but using harsh soaps or not rinsing thoroughly can lead to irritation.

3. Infection: Secondary infections, whether fungal (like Candida) or bacterial, can complicate the situation. Your mention of previous treatments for fungal infections suggests that this could be a recurring issue.

4. Skin Conditions: Conditions such as eczema or psoriasis can also manifest in the genital area, leading to symptoms similar to balanitis.
5. Underlying Conditions: Diabetes or other systemic conditions can predispose individuals to infections and skin issues.

Solutions and Management Strategies
1. Avoidance of Known Allergens: Since you suspect that the anti-inflammatory medication triggered your symptoms, it’s crucial to avoid any similar medications in the future. Always inform healthcare providers about your allergy history.

2. Topical Treatments: While you have tried various topical treatments, it’s essential to ensure that they are appropriate for your condition. For example, corticosteroids can reduce inflammation but should be used cautiously to avoid skin thinning. If you are using a combination cream (like the one with zinc oxide, Miconazole, and Gentamicin), monitor for any adverse reactions, especially if the skin appears to be worsening.

3. Consultation with a Dermatologist: Given the persistence of your symptoms and the lack of improvement, it may be beneficial to consult a dermatologist who specializes in skin conditions. They can perform patch testing to identify specific allergens and recommend tailored treatments.

4. Consider Systemic Treatments: If topical treatments are ineffective, systemic medications may be necessary. This could include oral antifungals or other medications that address underlying conditions.

5. Lifestyle Modifications: Maintain good hygiene, but avoid over-washing, which can strip the skin of natural oils. Use mild, fragrance-free soaps and ensure that the area is dry after washing.

6. Regular Follow-ups: Since you have seen multiple doctors without a clear resolution, consider establishing a consistent follow-up schedule with a single healthcare provider who can monitor your condition over time and adjust treatment as necessary.

Concerns About Long-term Use of Topical Medications
Using topical medications for extended periods can lead to side effects, including skin thinning, irritation, or even worsening of the condition. It’s crucial to have regular evaluations to assess the effectiveness of the treatment and make adjustments as needed. If you find that the current regimen is not yielding results, it may be time to discuss alternative therapies or a referral to a specialist.

Conclusion
Persistent balanitis following a drug allergy can be frustrating and uncomfortable. Identifying the underlying cause is key to effective treatment. By avoiding known allergens, consulting with specialists, and making necessary lifestyle adjustments, you can work towards alleviating your symptoms. Always communicate openly with your healthcare providers about your concerns and the impact of your symptoms on your quality of life.

Similar Q&A

Understanding Recurrent Balanitis: Causes, Treatments, and Prevention

Last October, I developed balanitis, and the doctor prescribed a steroid ointment. After using it, I saw significant improvement, but three weeks later, it turned into posthitis-balanitis (symptoms included: red spots on the glans, redness and swelling of the foreskin, and itchin...

Dr. Cai Zhuorong reply Urology
If there are recurrent inflammations, circumcision may be considered.

Persistent Glans Inflammation: Seeking Answers and Effective Treatment

Hello, Dr. Hsu. About a month ago, after having unprotected intercourse with a woman, I started experiencing a sharp pain in my penis, followed by peeling skin. I visited Dr. A, who said it was nothing serious, just minor skin abrasion, and prescribed me with Nystatin to apply. H...

Dr. Xu Weikai reply Urology
24-year-old male: For the care of the glans, the following recommendations are suggested: 1. Local cleaning: Use cold water only. Do not use any body wash, soap, or medicated soap. 2. After cleaning, apply petroleum jelly for maintenance. Theoretically, improvement should be seen...

Persistent Skin Pain: Understanding Prolonged Balanitis and Its Treatment

Hello Doctor: I have been experiencing balanitis for two months without improvement. I feel a slight sting when urinating and some itching. There is also a significant amount of post-void dribbling. Various tests for gonorrhea, syphilis, HIV, and chlamydia have all come back norm...

Dr. Wu Yuxin reply Dermatology
How to address the need to visually assess the skin condition before making a decision? Based on your description, it could potentially be urticaria combined with a candidal infection; however, I must emphasize once again that it is essential to see the skin condition in person t...

Persistent Balanitis: Understanding Symptoms and Treatment Options

Hello Doctor: Previously, I experienced inflammation of the foreskin due to masturbation, which has not completely healed. After consulting a urologist, I was prescribed tetracycline and a steroid ointment, but the results have been limited. The inflammation recurs as soon as I s...

Dr. Du Shixi reply Urology
Hello: If you have sexual intercourse, the inflammation may be caused by the sexual activity rather than masturbation. It is important to practice safe sex. If there has been unsafe sexual behavior, a visit to the urology department for examination may be necessary. Additionally,...