Centro Studi GISED

Genital lesions

Dear Dr Lorenzo Peli, I would like to ask you a question in reference to a problem of genital dermatitis. I am affected with sclero-atrophic lichen of the epidermis around the glans penis. Such a problem has never given me too many problems and in the past, by means of a surgical intervention the elasticity of the skin was noticeably improved in that area. After having had a tooth extracted I was on antibiotics and if I remember rightly it was... The assumption of these antibiotics seemed to cause peeling of all the epidermis with lacerations right in the same place as the dermatitis. I sincerely thought I had found a drug to overcome such a phenomenon, but it isn’t so. Actually, after having given up taking the antibiotics, the skin where there was this problem still seems less elastic than before. I wanted to know if it’s possible to actually eliminate such a problem with preparations or will the existing problem remain? Thank you.

Dear Sir, the problem that you have indicated could be an adverse reaction to the medicine. I advise you to check the name of the drug and therefore pay a visit to you doctor highlighting the event, if he confirms the hypothesis of an adverse reaction to the medicine, he will take steps to forward a report to the Pharmacovigilance Service. He will advise you to avoid further use of the suspected medicine. With regard to the basic problem (the Lichen), New treatments worthy of being pointed out haven’t emerged, unfortunately. Best regards, Dr Lorenzo Peli – GISED

Dear Doctor, My name’s (…) and I am affected with sclero-atrophic lichen of the genitals. This has created phimosis on the foreskin that makes it difficult to reveal the glans penis when erect. Further to the white sclerotic ring a white mark under the skin is also present on the glans penis. I wanted to ask if I have to be circumcised (if yes, is it a dermo-surgeon who carries out the operation or a urologist?) or if I have to take some kind of pharmacological therapy. Am I at risk to some other pathology more serious than Lichen? Awaiting you reply, thank you.

Dear Sir, Thank you for your message. Sclero-atrophic lichen is an chronic inflammatory disease in which the cause is unknown and which frequently affects the genitals. Unfortunately, interventions that are undoubtedly effective are not available for the treatment of sclero-atrophic lichen. Topical cortisone cream is used in the first instance. When, as in your case, it produces phimosis, circumcision is recommended. Best regards. Dr Luigi Naldi. Coordinatore Gruppo Italiano Studi Epidemiologici in Dermatologia. (GISED).

Browsing through the internet I visited your website and I decided that you were the right professionals to give advice on my dermatological situation. Let me briefly explain: around 10 years ago I noticed the appearance of some brownish marks on my penis (both the glans penis and foreskin). Alarmed, I immediately went to a dermatologist for a more precise diagnosis. I must say first of all that I have visited various different dermatologists from various towns in Italy. Everyone of them has given a different diagnosis. The first dermatologist diagnosed me as having lichen and I underwent a treatment without any beneficial results. The second believe that it was common dermatitis instead, said that it didn’t require any specific treatment and said that the marks would remain. Not content I visited a distinguished dermatological institution... and in this case they told me not to worry because they were simply marks (they gave me the example of the kind of marks that you find on your hands at a certain age…actually, they’re very similar). Moreover, they told me that should the marks get larger or multiply in numbers that I should go back again in order to take a tissue sample for a biopsy. This last diagnosis had me totally convinced (probably influenced by the prestige of the building) but today, I’m no longer as certain. Before I explain the reason for all this back-tracking I would like to clarify that these marks have even been seen by the most important doctors in... (urologists) who then gave me an operation for varicoceles. Even they thought they were just marks on the skin. Today the number of marks has increased (even if it’s not by much), but the thing which worries me the most is that for several months I have been suffering from intense irritation, particularly uncomfortable in as much as it provokes severe itchiness at the base of the glans penis. My worry is derived most of all from the fact that the doctor who had diagnosed it as lichen had also explained to me that this type of illness provokes atrophy of the foreskin. I’m 27 and you can well understand the great embarrassment both physically and psychologically that I’m forced to live with. I would like, above all, the advice of one of you on what I should do (go for another visit, where?, if there are specialist centres) and what are the negative consequences if it turns out that I have got lichen? Could you give me a more complete picture of the situation?And on the basis of my description could you hazard an opinion? Thank you very much.

Dear writer, it’s very difficult to give you a response without having seen the lesions. From your description I would be tempted to believe that it’s simply melanosis of the penis, a condition characterised by the appearance of flat marks of various colours from beige to brown, that can slowly grow in numbers and size over time. They are, however, totally asymptomatic and the troubles that you have averted to are probably attributed to concomitant inflammation. I believe that it’s counterproductive to go around from one specialist to another in search of a response. I would advise you to trust yourself to just one dermatologist and stick to his recommendations, if need be, go back for a check-up visit (in order to allow an evaluation of the lesions). Best regards. Dr Lorenzo Peli – GISED.

Hi, I would like to make you aware of a few problems. I’m 33 and for a bit of time now I’ve had a spot on the base of my penis about 1cm away from my scrotum. Probably because it can’t manage to drain itself completely, it starts reproducing a secretion every so often. To touch it seems like there’s a small, hard accumulation of it under the skin. Notwithstanding the fact that that area is kept clean and shaved and notwithstanding the fact that the area’s treated with zinc oxide to keep it soft and if needs be, to help with the healing in periods of intense heat, it comes back again. What can I do? Thank you.

Dear Sir, Thank you for your message. The persistence over a period of months of a nodular lesion, like the one you describe at the base of your scrotum is rather unusual and requires a precise diagnosis. I therefore advise you to go and pay you doctor a visit and if required go to see a dermatologist. Best regards, Dr Luigi Naldi coordinatore Gruppo Italiano Studi Epidemiologici in Dermatologia (GISED).

I’m a Pharmacist and a doctor has asked me if it’s possible to apply a permetrina based preparation onto the genitals of adults and babies. In the case of an answer in the affirmative, at what percentage? Thank you.

Dear Doctor, thank you for your message. 5% permetrina in a cream base can be used in the treatment of scabies and pediculosis of the pubis. The drug has also been used in babies. The application can also be used on the genitals. Best regards Dr Luigi Naldi coordinatore Gruppo Italiano Studi Epidemiologici in Dermatologia (GISED).

Dear Doctor, following unprotected sex with a person that I see often, I’ve noticed that my glans penis has become inflamed and itchy. I don’t have a burning sensation when I urinate nor when I have sex. I just have this constant itchiness and inflammation. I’m quite worried and I would like to know what it could be and what are the possible remedies? Thank you very much.

Dear Sir, it’s always recommendable to have protected sex with occasional partners. The symptoms that you refer to are rather unspecific. It could just be an ordinary infection by candida or it could be caused by some irritant. I think it would be a good practise to consult a doctor. Dr Luigi Naldi coordinatore Gruppo Italiano Studi Epidemiologici in Dermatologia (GISED).

Dear Doctor, I am a teacher of 35 years and I live in... I’m writing to you because for the last few months I have noticed small little vesicles have appeared on the base of the glans penis: they’re very similar to small spots, they’re light in colour and completely painless. I am seeing a woman regularly who had, in the past, suffered from candida, which I sadly only found out about after we had already had unprotected sex numerous times. We actually use a condom now and the doctor that I went to see suggested that I might use an antimicotic cream. After 2 months of using the treatment there was no change: no deterioration, no discomfort, but no improvement either. I would be infinitely grateful to you if you could give me some of your precious advice: I don’t know if the diagnosis is the right one, nor do I know if the treatment I’m using is appropriate. Thank you for your time, I hope you can help me. Yours respectfully.

Dear Writer, the presence of the translucent little white spots of hard consistency that you have found at the base of the glans penis (in particular, close to the fraenum) could be completely normal and not representative of any disease. Particularly because the symptoms you describe are not typical for an infection by candida. I would advise you even so, to go for a visit to a dermatologist. Best regards, Dr Lorenzo Peli – dermatologist –GISED.