Is there any scale involved? Or just white patches? Do you have any white patches any place else?Customer :no dont on any other place. i dont thing scales are involveddermdoc19 :They are flat then. Just areas without pigmentation?Customer :yeah mostly flat, but its around the shaftdermdoc19 :May I ask your ethinic background?Customer :Asiandermdoc19 :OK. One thing to consider is vitiligo. The penis shaft is an area in which vitiligo can frequently start. If there is no scale and the areas are just losing pigment there is a fairly good chance this is what is happening. I would recommend a dermatologist since this is a skin disease and not a urologic problem.Customer :Does it take a long time to cure? And one more thing, some times it itchesdermdoc19 :When treated early, this is a fairly easy condition to treat. It usually responds to a steroid cream,Protopic which is what we call a calcineurin inhibitor.It often takes a few months. Resistant cases can be treated with the Eximer laser.Occasionally, vitiligo can itch slightly but if there is severe itching it is probably something else.Iron and folate will help the pigment come back too.The best OTC prodcut would be Maximum Strength Cortaid Ointment. You can use this twice a day before seeing the doctor.Customer :What is folate?dermdoc19 :Folate is the same as folic acid, one of the B vitamins.It is often combined with iron. and can be found in the vitamin section of any pharmacy.Customer :I have an appointment with the doctor day after...with the dermatologist. Let me try and send you a photograph of it now so that you will have an idea
Here you can see the black spots toodermdoc19 :I am glad you send the photograph. This does not look like Vitiligo, so scratch the advice I gave earlier.This looks like a rather rare condition: the annular variant of lichen planus. You also have pearly penile papules in the sulcal area, the grove between the shaft and the head of the penis.This would also explain the itching.Customer :I'm not worried about the Pearly Penile Papules those are common cause i have them from long time. im maily worried about the other white patches which spread and as you can see those became black on head of the penisdermdoc19 :Yeah...I thought that would be a secondary thing.dermdoc19 :No oral sores or nail changes? Do you have any sores in your mouth or nail abnormalities.Customer :nodermdoc19 :I am also considering Balniltis Xerotica Obliterans which is a form of lichen sclerosus involving the penis.Customer :Is it harmful?dermdoc19 :I thought this first, but cases I have seen only had a few bands....Not harmful but difficult to deal ;with.Customer :it has been more than a month or two since these appeared. first i thought they are fine might have caused due to some rashes but they never disappeared so i was worried nowdermdoc19 :I am attending a dermatology meeting tonight and would be happy to show your pictures to a few of my astute colleagues to get their opinion. I do tell you this: it is not an easy diagnosis. You should definitely see a dermatologist, it will be beyond the ken of familly physician. I feel it is one of the two. The more I think of it I think it is more consistent with BXO.Customer :ok. will you let me know about their opinion?dermdoc19 :Definitely.I did attend the dermatology meeting tonight and showed the pictures to three dermatologists. The concurring opinion was that this was lichen planus. We would recommend a potent steroid for three weeks and if not improved a skin biopsy.Customer :ok thank you. And one more thing; i have an appointment tomorrow with a dermatologistdermdoc19 :Let him/her come to their own conclusion. Then you can suggest lichen planus if it differs. You did get four opinions tonight.Customer :ok. thanks i really appreciate itdermdoc19 :You're welcome. I waited until the dinner was over for obvious reasons.Customer :potent steriod in the sensedermdoc19 :Two weeks with a something like Betamethasone Dipropionate.Customer :is it an ointment ordermdoc19 :Ointment would be better.Customer :how many times a day do i need to applydermdoc19 :Twice.Customer :ok. do i need a prescription to buy from pharmacy?dermdoc19 :For what you have, I strongly doubt anything OTC will budge it. The strongest Over the counter medicatoin would be Maximjum Strength Cortaid ointment. I do not feel it is strong enough for lichen planus. In my experience it requires a prescription strength steroid ointment.Customer :ok. Anyhow will be going to the dermatologist hopefully that helps, and cures real fast. thanks for the information and your timedermdoc19 :You are welcome. Let me know what happens.