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Dr. Bob
Dr. Bob, Medical Doctor
Category: Dermatology
Satisfied Customers: 5331
Experience:  20 Years in Internal Medicine, Neurology and Sports Medicine
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Swollen / inflamed & red rim of penis glans time - Ring like

Customer Question

Swollen / inflamed & red rim of penis glans for a long time
- Ring like spot on penis glans
- Another white spot on penis glans
None of these have caused any major itchiness or pain. My foreskin is a bit tight and doesn't easily come on top of the glans when masturbating, which might cause some inflammation(?) I haven't ever been in a sexual intercourse.
What could this be?
Submitted: 1 year ago.
Category: Dermatology
Expert:  Dr. Bob replied 1 year ago.

Are you diabetic? Does it run in your family?

Customer: replied 1 year ago.
I'm not a diagnosed diabetic and I don't have any symptoms. There's some diabetes in my family from my mothers side, but as I said, I've never had any symptoms. I've attached a picture of the white spot. I also get small random red bumps every now and then that go away quickly and resurface randomly as seen in the picture.
Customer: replied 1 year ago.
I should also add that the picture doesn't really do justice to the spot, but it was the best one I could get. Also the redness looks a bit more mellow here than normally, so the contrast is a little off.
Expert:  Dr. Bob replied 1 year ago.

If you have not been checked for diabetes in the past 6 months ago, you should consider it as balanitis is a common presenting symptom. It can cause redness of the rim of the penis, as well as swelling and whitish debri. That said, this does not look like classic balanitis (which is an easily treated fungal infection, by the way). You could try an over-the-counter antifungal cream for a couple of weeks to see if it starts to clear. Another possibility would be something temporary such as lichen planus.

Expert:  Dr. Bob replied 1 year ago.

Lichen planus is a chronic inflammatory skin condition affecting skin and/or mucosal surfaces, often affecting the penile glans or shaft.

Expert:  Dr. Bob replied 1 year ago.

Another consideration would be Balanitis xerotica obliterans...a chronic, sclerotic dermatitis involving discrete, angular, white, atrophic macules and patches on the glans, prepuce, and foreskin of the penis, with only rare involvement of the shaft. Fissures and erosions can sometimes appear over the glans. Phimosis, the inability to retract the foreskin over the corona of the penis completely, and paraphimosis, the inability to extend the foreskin over the glans, are potential sequelae.

Customer: replied 1 year ago.
I added one more photo from the other side (the ring shaped spot). Also another picture with a brighter light to show the redness.My foreskin is easily retracted, but when erect, it can hit the lower glans in motion which seems to cause some irritation. I can never see any white stuff under my foreskin and I wash it daily. The white spot that I showed you in the earlier picture also seems to be present on the foreskin that covers the area in the same shape. I can feel it, but it doesn't cause any real itchiness. I was also thinking about Lichen Planus, but I've been thinking if there's a connection between the redness of the rim and the spots, however, I've only noticed these spots a couple weeks ago and to my knowledge, my rim has been red and inflammed for a longer time.Thank you.
Expert:  Dr. Bob replied 1 year ago.

You might have 2 things going on at the same time. Something like lichen planus explaining the macules and something like an irritant or contact dermatitis explaining the red rim. This could be from a soap you are using or a lubricant, for example. In some cases, it is mechanical from the friction of sex or masturbation, particularly if no lubricant is used. Finally, do consider balantis again, as this can do both.

Customer: replied 1 year ago.
Does the white spot resemble lichen planus? There are also a few, albeit smaller spots near the rim that can be seen with eye that are similar to the white spot. Those seem to come and go or they just aren't that noticeable. Can the lichen planus be present on both the foreskin and the glans identically on the same spot?And finally, should I just wait for the lichen planus to clear up by itself and also avoid friction with the rim and see if it heals up (which could take a while)? I've noticed that sometimes after activity with the penis the rim becomes more red and when it's been sitting under my foreskin for a longer time with no activity, it appears more blue/purple.I will also consider the balanitis.
Customer: replied 1 year ago.
I forgot to add that I don't use any soap etc. to clean down there, just plain water. So if it's from irritation, it'd have to be from contact.
Customer: replied 1 year ago.
One more thing.. You don't think it could be yeast infection? This is getting a bit confusing I know, but sometimes when I have my foreskin pulled back for a long time, my glans will become yeasty-looking, but that could just be from dryness(?) There's no discharge. This resolves when I pull the foreskin back on top of the glans and back down again.Thanks for your effort.
Expert:  Dr. Bob replied 1 year ago.

The white spots do resemble lichen planus or lichen sclerosus. They can appear anywhere on the penis but are less common on the shaft. Not sure why a spot would be present on both the foreskin and glans at the same spot unless it was a coincidence or possibly a fungal balanitis (yeast) that has infected both places by direct contact. This latter condition would improve within a few days to weeks with an antifungal cream (e.g. miconazole, clotrimazole)

Expert:  Dr. Bob replied 1 year ago.

Lichen planus or scerosus on the skin often clears up on its own in a couple years or less. If the disease affects your mucous membranes, it tends to be more resistant to treatment and more prone to recur. The first choice for treatment is usually a prescription corticosteroid ointment, to help reduce inflammation. If that doesn't help and your condition worsens, your doctor might suggest a corticosteroid pill, either alone or with the ointment. If you still don't see improvement, your doctor might suggest a corticosteroid injection. Hopefully, this would not be necessary. :-)

Customer: replied 1 year ago.
should I get treated for the lichen planus or scerosus if it's not bothering other than aesthetically? Also 1 more thing comes to mind that could have something to do with this. I've been recently told that my pee sometimes tends to smell a little like ammonia. Not sure if I could have an underlying UTI or something else that could be contributing to a skin condition.. I have no burning sensation/pain when peeing, although some small amounts of pee tends to get stuck in my urethra after I'm finished. All very confusing, haha.I'm still not 100% sure where to go with the redness of the rim though, do you think I should try abstaining from friction for a period of time? I've tried to do this for 7+ days, but didn't really see much improvement (perhaps there was some..). The upper part of the rim seems to have some cracking and there's some mild ulceration around it when looked under a bright light.I wont be bombarding you with anymore questions after these. Thanks for all the effort. :)
Expert:  Dr. Bob replied 1 year ago.

I don't think you need to treat unless, as you say, yoy are concerned about it asthetically. As for the ammonia smell to your urine, this is often due to the urine getting too concentrated such as when dehydrated. If it smells sweetish, get tested for diabetes. Try to avoid friction to the corona as much as possible. Consider using a mild corticosteroid cream such as hydrocortisone 1% to address the irritation and cracking of the skin.