Presenter: Matthew Muellenhoff , DO, Thi Tran, DO, Frank Armstrong , DO , Kathleen Soe, DO, Greg Houck, DO , Marya Cassandra, DO

Dermatology Program: Sun Coast Hospital, NOVA Southeastern University

Program Director: Richard Miller, D.O.

Submitted on: November 29, 2004

CHIEF COMPLAINT:  Rash on the Penis

CLINICAL HISTORY: A 58-year-old uncircumcised white male presented to our dermatology clinic for evaluation of a “rash” on his penis for >5 years. Past medical history was significant for hypertension, hyperlipidemia, and coronary artery disease. He had used over the counter products such as Gold-Bond ointment, Vaseline, and cortisone without benefit. Localized irritation with coitus, duration of the “rash” and concern of “what it is” brought him to our clinic.

PHYSICAL EXAM:
Physical examination revealed a well-nourished, middle-aged uncircumcised white male in no acute distress. The glans penis revealed a discrete, glistening erythematous plaque. Penile discharge, ulcerations, and adenopathy were absent. The ocular and oral mucosa failed to reveal any lesions. The patient denied any significant review of systems, specifically, the musculoskeletal and ophthalmological. The patient also claimed to be monogamous for the previous 10 years and denied any risk factors for sexually transmitted diseases.

A 2 week trial of ciclopirox cream and triamcinolone acetonide 0.01% cream failed to provide any benefit.

LABORATORY TESTS:

Serologies for HIV and syphilis were negative. The culture of the plaque revealed normal commensal flora.

DERMATOHISTOPATHOLOGY:

A punch biopsy was performed at the follow-up visit. Histopathologic findings included a thin epidermis, uniform intercellular edema, and pancake-like keratinocytes. The upper dermis demonstrated a lichenoid infiltrate with copious plasma cells. Capillary dilatation was also noted.

DIFFERENTIAL DIAGNOSIS:

1.   Syphilis
2.   Bowen’s disease
3.   Zoon’s balanitis
4.   Extramammary Paget’s
5.   Psoriasis