Benign male genital dermatosesBMJ 2016; 354 doi: https://doi.org/10.1136/bmj.i4337 (Published 11 August 2016) Cite this as: BMJ 2016;354:i4337
- Tang Ngee Shim, consultant dermatologist1,
- Iaisha Ali, consultant dermatologist2,
- Asif Muneer, consultant urological surgeon and andrologist3,
- Christopher B Bunker, consultant dermatologist4
- 1University Hospital, Coventry CV2 2DX, UK
- 2Imperial College Healthcare Trust, London, UK
- 3Department of Urology and NIHR Biomedical Research Centre, University College Hospital, London, UK
- 4University College Hospital, London, UK
- Correspondence to: T N Shim
Males with genital skin disease may present to clinicians in primary care, dermatology, genitourinary medicine, or urology clinics. Male genital dermatoses encompass a wide variety of skin lesions and rashes, some of which are limited to the genital area whereas others, such as psoriasis, can be part of a more generalised skin disorder. Genital skin disease can impact on the physical, psychological, and sexual wellbeing of men. Some dermatoses are precancerous, and cancer of the penis is associated with morbidity and mortality and litigation.1 This clinical update provides a guide to normal anatomical variations of the penis, how to recognise and manage common benign male genital dermatoses, and when to refer for specialist opinion.
Sources and selection criteria
We searched PubMed and Google Scholar for clinically relevant studies (Jan 2000 to Jul 2016), and the Cochrane Library, using the search terms “Balanitis”, “Balanoposthitis”, “Penile Dermatoses”, “Genital Dermatoses”, along with terms specific to each condition. We consulted the Cochrane Library, National Institute for Health and Care Excellence, British Association of Dermatologists, and British Association for Sexual Health and HIV for guidelines.
How do patients with penile dermatoses present?
Patients may be asymptomatic or describe pruritus, soreness, pain, dyspareunia, splitting of the foreskin, non-retractile foreskin (phimosis) or foreskin fixed in retraction (paraphimosis), scaling, erosion, and ulceration.2 3 The foreskin is a delicate tissue that is in close contact with urine, sweat, moisture, sexual secretions, desquamative products, detergents, potential allergens, and microbes. These factors may expose the foreskin to general irritation, pain, and dysfunction (eg, paraphimosis or phimosis, dribbling of urine, dyspareunia).3 4 Further progression of infection and inflammation can cause scarring, disfigurement, and, rarely, precancerous or cancerous lesions. Most men presenting to a specialist male genital dermatology clinic are uncircumcised.5 Circumcision protects men from inflammatory genital dermatoses, including psoriasis, seborrhoeic dermatitis, lichen planus, and lichen sclerosus.5 Predisposition to …