Dry Cracking of the Foreskin: Causes and Treatments

Phimosis with fissuring of the foreskin?

Hello, Dr.
Hsu:
Condition 1: Recently, I have been experiencing dryness and cracking of the foreskin (in lines), which becomes more pronounced after an erection.
After masturbation, the cracked areas sometimes peel, and I feel a stinging sensation when washing with body wash or water.
However, if I do not masturbate that day, there is no pain, although the dryness is still noticeable.
Condition 2: Near the glans, there are flakes that appear only after rubbing or masturbation.
Occasionally, there is slight redness and mild itching.
The key point is that this situation has persisted for 9 months without seeking medical attention, although I have been applying an antifungal cream, which provides some improvement.
However, if I stop using it for a few days, the symptoms return, which is quite bothersome.
Initially, there was an unusual odor, but that has since resolved.
Question 1: Condition 1 is a recent development, while Condition 2 has lasted for about 9 months.
Are these two conditions related? Are they the same condition?
Question 2: What topical treatments can I apply to improve the situation?
Question 3: If I need to seek medical attention, should I consult a urologist or a dermatologist?
Thank you.

shi yan, 20~29 year old female. Ask Date: 2015/12/30

Dr. Xu Weikai reply Urology

Hello, it is not recommended to use body wash for cleaning the glans.
Care instructions: 1.
Clean the glans several times a day.
2.
It is best to clean any smegma after each urination; if not convenient, simply pat dry the area.
3.
Cleaning method: use only cool, clean water.
Absolutely avoid soap, body wash, or any cleaning agents.
If you feel dryness, you may apply a small amount of petroleum jelly, baby oil, or a gentle, non-irritating moisturizer.
4.
If this issue occurs frequently, there may be other underlying problems, and it is advisable to seek professional medical advice.
I believe the issue lies in the cleaning and care of the glans.
If there are any unclear points, feel free to ask again for further discussion.
Online responses should only serve as a reference; if necessary, it is essential to visit a medical facility.
This message is from Dr.
Hsu Wei-Kai, Director of the Urology Department at Taitung Hospital, Ministry of Health and Welfare.

Reply Date: 2015/12/30

More Info

Understanding dry cracking of the foreskin can be quite concerning, especially when it leads to discomfort and potential complications. Based on your description, it appears that you are experiencing two distinct but potentially related issues: dry cracking of the foreskin and flaking near the glans (the head of the penis). Let's delve into the possible causes, treatments, and when to seek medical attention.

Causes of Dry Cracking of the Foreskin
1. Irritation and Friction: Frequent masturbation or sexual activity can lead to irritation of the foreskin, especially if there is insufficient lubrication. This can cause the skin to dry out and crack, leading to discomfort and pain.

2. Infections: Fungal infections, such as candidiasis (thrush), can cause flaking and irritation of the skin. The presence of flakes and mild redness you mentioned could indicate a fungal or yeast infection, especially if it improves with antifungal creams like the one you mentioned (療黴舒).

3. Dermatitis: Contact dermatitis from soaps, lotions, or other irritants can lead to dry, cracked skin. If you notice that symptoms worsen after using certain products, this could be a contributing factor.

4. Poor Hygiene: Inadequate cleaning of the genital area can lead to the accumulation of smegma, which can irritate the skin and lead to infections.

5. Underlying Conditions: Conditions such as psoriasis or eczema can also affect the genital area, leading to dryness and cracking.

Treatment Options
1. Topical Treatments: Since you mentioned that using a topical antifungal cream has provided some relief, it may be beneficial to continue using it as directed. Additionally, consider using a gentle, fragrance-free moisturizer to help keep the skin hydrated. Over-the-counter hydrocortisone cream may also help reduce inflammation and itching, but it should be used sparingly and not for prolonged periods.

2. Avoid Irritants: Switch to mild, unscented soaps and avoid products that may irritate the area. Ensure that you rinse thoroughly after washing to remove any soap residue.

3. Gentle Hygiene Practices: Maintain good hygiene by gently cleaning the area with warm water and avoiding harsh scrubbing. If you are uncircumcised, ensure that you retract the foreskin during cleaning to prevent smegma buildup.

4. Lubrication During Sexual Activity: If you engage in sexual activity or masturbation, consider using a water-based lubricant to reduce friction and irritation.

When to Seek Medical Attention
Given that your symptoms have persisted for nine months, it is advisable to consult a healthcare professional. Both a urologist and a dermatologist can provide valuable insights, but a urologist may be more specialized in issues related to the genital area. They can perform a thorough examination, possibly conduct tests to rule out infections, and provide a tailored treatment plan.

Conclusion
In summary, the dry cracking of the foreskin and the flaking near the glans may be related, potentially stemming from irritation, infection, or dermatitis. It is essential to maintain good hygiene, avoid irritants, and consider topical treatments. However, given the duration and persistence of your symptoms, seeking medical advice is crucial for proper diagnosis and treatment. A healthcare professional can help determine the underlying cause and recommend appropriate therapies to alleviate your discomfort and prevent recurrence.

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