Common abnormalities of glans penis skin and prevention and treatment guidelines for eight typical glans penis diseases

(1) Pearly penile papules: In outpatient practice, young men often seek medical attention because of a row or several pinhead-sized, pearl-like papules on their glans penis. They are very worried, some fearing they have tumors, others fearing they have contracted sexually transmitted diseases. The rash is the size of millet grains, similar in color to the surrounding skin, and is neither painful nor itchy. Although it does not affect urination or sexual intercourse, it causes significant psychological stress. Medically, this is called pearly penile papules. This condition resolves spontaneously without treatment. The most important thing for patients is to understand the condition and relieve themselves of fear and anxiety.

(2) Leukoplakia: White spots of varying shapes may appear on the glans penis. Some are completely white, while others are lighter in color. They are painless and non-itchy, with a smooth surface and accompanied by other rashes. The color is darker than the normal skin color. This condition usually resolves on its own. Because leukoplakia of the glans penis is related to chronic irritation from smegma, and because leukoplakia has the potential to become malignant, men with phimosis or redundant foreskin who have leukoplakia of the glans penis should undergo circumcision as soon as possible.

(3) Erythema proliferativeis: Characterized by single or multiple erythematous patches on the glans penis, which may be round, annular, or irregular in shape, with clear borders, slightly raised and hard, and a shiny surface. Sometimes erosion, crusting, or papillary hyperplasia may occur. This condition may remain unchanged for many years, or it may become cancerous. The etiology of erythema proliferativeis is unknown, but it mainly occurs in men with phimosis. Therefore, all men with this condition should routinely undergo circumcision.

(4) Cutaneous horn: This manifests as a horn-shaped protrusion on the glans penis, about the thickness of a matchstick or chopstick, brown or grayish-brown in color, and hard in texture. Cutaneous horns are growths formed by the proliferation of epidermal keratinocytes on the basis of glans inflammation and are considered a precancerous lesion. The treatment method is local excision. It should be noted that patients with cutaneous horns of the glans penis should seek medical attention as soon as possible. They should not be embarrassed or attempt to remove them themselves, as this may worsen the condition or delay treatment, leading to serious consequences.

(5) Angioedema: Similar to urticaria, this is an acute allergic reaction of the glans penis caused by food, drugs, or insect bites. This condition can occur not only on the glans penis but also simultaneously with urticaria. Children are prone to glans penis edema, which manifests as significant swelling and shine of the foreskin at the glans, resembling large blisters, but does not affect urination. This condition often occurs at night, with minimal itching and no systemic discomfort, and usually resolves spontaneously after several days. For this condition, it is important to keep the area clean and dry. If necessary, a 1:1000 solution of benzalkonium bromide can be gently applied to the affected area. For those with concurrent generalized urticaria, oral chlorpheniramine or diphenhydramine can be used, but only under the guidance of a doctor.

(6) Tuberculous rash: Commonly occurs on the glans penis, presenting as small, pale red bumps (papules), painless and non-itchy, sometimes ulcerating to form small, round ulcers without pus, which gradually scab over and heal. Sometimes it may be accompanied by cutaneous tuberculous rash, manifesting as multiple rashes on the limbs, back, head, and neck, easily misdiagnosed as acne or follicles. The rashes appear and disappear in succession and can be absorbed spontaneously, but each rash generally takes 20-30 days to heal on its own. Tuberculous rash is caused by an allergic reaction of the skin to tuberculous lesions in other parts of the body; the lesions themselves do not contain Mycobacterium tuberculosis. Treatment for tuberculous rash should involve oral anti-tuberculosis drugs. Patients should not self-medicate and should consult a physician for guidance on medication.

(7) Genital warts: Symptoms typically appear 3 weeks to 8 months after sexual contact. Lesions are located on the glans penis, coronal sulcus, frenulum, urethral opening, etc., and appear as soft, papillary fleshy bumps, grayish-white, pale yellow, or pink in color, that bleed easily upon touch. They can be single or clustered, somewhat resembling cauliflower. Treatment requires cryotherapy or laser therapy.

(8) Molluscum contagiosum: It usually occurs 2 to 7 weeks after sexual contact, and appears as a hemispherical papule with a diameter of 3 to 6 mm and a slightly concave center, like an umbilicus. If the papule is squeezed, a white, cheesy substance can be squeezed out. Treatment can be done by scraping it off with a sharp curette, then applying iodine or carbolic acid, and applying pressure to stop the bleeding; cryotherapy can also be used.

(9) Fungal balanitis: Caused by a fungus called Candida, it generally occurs in patients who have undergone circumcision. The glans penis is red and shiny, with small pustules or papules on the surface. Clotrimazole or ketoconazole can be taken orally, and clotrimazole ointment can be applied to the affected area.

(10) Balanoposthitis: This is the most common balanitis. Between the glans and the foreskin, a warm, moist culture medium for bacteria forms due to shed epithelial cells, glandular secretions, and smegma. Once bacteria enter, inflammation can occur. In the early stages of balanoposthitis, edema and congestion are visible on the surface of the glans and foreskin. Redness and erosions appear around the urethral opening, which can develop into superficial ulcers with purulent discharge. Patients experience itching or burning sensations at the glans, followed by pain. After ulceration, purulent discharge with a foul odor may occur. In severe cases, fatigue, low-grade fever, and swollen and tender inguinal lymph nodes may also occur. Treatment for balanitis can involve soaking the glans penis in a 1:5000 potassium permanganate solution twice a day, morning and evening. Alternatively, a cotton swab dipped in a 1:1000 benzalkonium bromide solution can be used to gently wipe away any exudate or pus. Avoid using ointments and powders, as these may worsen the condition. For patients with severe systemic reactions, antibiotics may be used in conjunction with treatment.

(1) Superficial balanitis: often caused by phimosis, chronic irritation from smegma, local friction, soap irritation or trauma, bacterial infection, etc. It manifests as patchy erythema, erosion, secretions, ulcers, etc. on the glans mucosa, with itching or burning pain. In severe cases, it may be accompanied by general weakness, low-grade fever, lymphadenopathy, etc.

(2) Candidal balanitis: It is more common in people who have been using antibiotics or hormones for a long time, diabetic patients, and those with weak constitutions. Smooth red patches appear on the glans mucosa, with small vesicles and desquamation at the edges. The patches gradually expand outwards. Candida can be found by taking skin scrapings from the lesion and examining them under a microscope.

(3) Trichomonal balanitis: It is more common in men whose partners have severe trichomonal vaginitis. The typical lesions on the glans penis are papules, erythema, small vesicles, and erosions. Trichomonas can be found in the secretions.

(4) Fixed drug eruption of the glans penis: If a man develops a nearly circular, edematous, purplish-red or bright red patch on the glans penis mucosa within a few hours to 20 days after taking sulfonamides, antipyretics, analgesics, or sedatives, accompanied by burning or pain, and the patch gradually fades after discontinuing the medication, leaving pigmentation after healing, this is a fixed drug eruption caused by an allergic reaction to the medication. It recurs at the same reaction site each time the same medication is taken, and the pigmentation becomes increasingly dark.

(5) Penile cancer: It usually occurs in people over 35 years of age, and all patients have a history of phimosis or redundant foreskin and balanitis. It manifests as a slow-growing and enlarging induration, erythema, and ulcers with bloody discharge. In the late stage, it becomes cauliflower-like and is accompanied by pain.

(6) Genital warts on the glans: mostly caused by viruses, appearing as pale red or dirty cauliflower-like protrusions with a foul odor.

(7) Balanitis tuberculosis: Small to large papules or nodules on the glans penis in patients with pulmonary tuberculosis or other tuberculosis, with no obvious subjective symptoms.

(8) Balanitis: A history of unprotected sex, a single hard nodule appears on the glans, and the surface quickly becomes eroded and ulcerated, but there is no pus and no pain.

In conclusion, discomfort in the glans penis can be caused by many different diseases. Patients should seek medical attention promptly for treatment targeting the underlying cause.