How do you explain this persistent eruption on the glans?

March 2, 2010

Is this penile rash the result of lichen planus? Candidiasis? A dermatophyte infection? Seborrhea? Psoriasis? Click here for the answer.

Case 2:

A 38-year-old man presents for evaluation of a rash on the head of the penis that has persisted for a few weeks. He has no other rashes. What is your clinical impression?

A. Lichen planus.
B. Candidiasis.
C. Dermatophyte infection.
D. Seborrhea.
E. Psoriasis.

Answers on Next Page

Signs and symptoms of this candidal infection, B, vary but may include tiny papules, pustules, vesicles, or persistent ulcerations on the glans penis. Exacerbations following intercourse are common.

Topical antifungal therapy is sufficient in most patients. Evaluate asymptomatic sex partners and treat them if they are affected. If persistent lesions spread beyond the genitalia, consider the possibility of diabetes mellitus and assess the patient for the disease.

Lichen planus is characterized by purple polygonal papules that do not resemble this patient's rash. Dermatophyte infections of the penis are possible but rare. Seborrhea features more scale than is seen here. Psoriasis is less likely if the patient has no psoriatic lesions elsewhere on the body.