What is this rash and how would you treat this chronic condition?

This 52-year-old male presents with a 2.5 year history of a cracking bleeding rash on the corona.

1. What is the diagnosis?

A.Candida balanitis.

B.Balanitis xerotica obliterans.

C.Dermatophyte infection.

D.Psoriasis.

E.Lichen planus. 

2. How would you treat this chronic condition?

A.Low potency topical corticosteroid (desonide, hydrocortisone valerate, or hydrocortisone butyrate). 

B.Calcipotriene.

C.Calcitriol. 

D.Tacrolimus/pimecrolimus.

E.Systemic treatment.

ANSWER—Psoriasis

You would typically look for other signs of psoriasis (nails, scalp, belly button, axillae—seborrheic distribution areas). Biopsy can be helpful if necessary. Lichen planus is usually not that scaly in this location. Dermatophyte is extremely rare unless diabetic or immune compromised (same with Candida). Balanitis xerotica obliterans (BXO) is usually inflammatory with atophic scarring with hypopigmentation.

Since the condition is chronic, use intermittent low potency corticosteroids or any one of the nonsteroidal options. Since genital psoriasis can be emotionally devastating, systemic therapy is not unreasonable and often covered by insurance plans.