Summary
Definition
History and exam
Key diagnostic factors
- uncircumcised state
Other diagnostic factors
- multiple sexual partners
- high-risk sexual behaviors
- postinflammatory hypo- or hyperpigmentation
- pruritus
- red scaly patches
- erosions
- personal/family history of atopy (eczema, hay fever, asthma, type I allergies)
- personal/family history of psoriasis
- urinary dribbling
- hypopigmentation
- purpura
- red plaques
- blisters
- papules or micropapules
- pustules
Risk factors
- congenital or acquired dysfunctional foreskin
- uncircumcised state
- poor hygiene; urinary dribbling or leakage
- overwashing
- human papillomavirus (HPV) infection
- inflammatory skin diseases
Diagnostic investigations
1st investigations to order
- swab for microbiology (Gram stain and culture) and PCR
- swab for virology
- dark-field microscopy
Investigations to consider
- skin biopsy
- patch testing
Emerging tests
- dermoscopy
Treatment algorithm
atopic eczema
seborrheic dermatitis
irritant contact dermatitis
allergic contact dermatitis
psoriasis
reactive arthritis (Reiter disease)
lichen sclerosus
gonorrhea
candidosis
nonspecific balanoposthitis
Zoon balanitis
carcinoma in situ/penile intraepithelial neoplasia (PeIN)
Contributors
Authors
Ien Chan, MD, FRCP
Consultant Dermatologist
Chelsea and Westminster Hospital
London
UK
Disclosures
IC declares that he has no competing interests.
David Hawkins, FRCP
Consultant Genitourinary Physician
Chelsea and Westminster Hospital
London
UK
Disclosures
DH declares that he has no competing interests.
Christopher Bunker, MA, MD, FRCP
Consultant Dermatologist
Honorary Professor of Dermatology
University College London
Chelsea & Westminster Hospitals
London
UK
Disclosures
CB is the owner and CEO of Bruce Shrink Ltd., the publisher of Male Genital Skin Disease, an e-book authored by CB. He has done consultancy work for the British Skin Foundation. The fee for this work is usually paid to the British Skin Foundation. He is the honorary secretary of the British Skin Foundation, the senior Medical Trustee. CB has provided advice to MC2, with a pipeline lichens sclerosis product, for which he has not received payment. CB does a dedicated weekly male genital clinic at University College London Hospitals from which his employer receives income. CB is a frequent speaker at meetings on male genital dermatology and is in receipt of a grant from a private donor, administered by the British Skin Foundation, to investigate the relationship of lichen sclerosus to penis cancer. He is an author of a number of references cited in this topic.
Peer reviewers
Colm O'Mahony, MD, FRCP, BSc, DIPVen
Consultant in Sexual Health
Department of Sexual Health
Countess of Chester Hospital NHS Foundation Trust
Chester
UK
Disclosures
CO declares that he has no competing interests.
Sarah Edwards, MD
Consultant
Department of GU Medicine
West Suffolk Hospital
Suffolk
UK
Disclosures
SE declares that she has no competing interests.
David Paige, MD
Consultant Dermatologist and Honorary Senior Lecturer
Dermatology Department
The Royal London Hospital
London
UK
Disclosures
DP declares that he has no competing interests.
Jashin Wu, MD
Chief Dermatology Resident
University of California
Irvine
CA
Disclosures
JW declares that he has no competing interests.
Christopher Huston, MD
Assistant Professor of Medicine
Division of Infectious Diseases
University of Vermont College of Medicine
Burlington
VT
Disclosures
CH declares that he has no competing interests.
Nanette Silverberg, MD
Clinical Professor of Dermatology
Columbia University College of Physicians and Surgeons
New York City
NY
Disclosures
NS declares that she has no competing interests.
Julian Trevino, MD
Associate Professor of Dermatology and Dermatology Residency Program Director
Boonshoft School of Medicine
Wright State University
Dayton
OH
Disclosures
Speaker's Bureau, Stiefel; Consultant, Abbott.
Differentials
- Eczema and dermatitis
- Atopic dermatitis
- Seborrheic dermatitis
More DifferentialsGuidelines
- Sexually transmitted infection treatment guidelines, 2021
- British Association of Dermatologists guidelines for the management of lichen sclerosus
More Guidelines
Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer