Ongoing redness on foreskin and glans for 7 years

Hi,

I have been suffering from quite a condition for the past 7 years. There is quite a lot of information here and I am trying to understand my best next steps. Thanks in advance for your help.

7 years ago, I had sex but the condom broke. I had a perfect penis, no problems, especially no dermatitis problems at all. And also have no dermatitis problems elsewhere on my body anywhere, and not much family history of skin issues.

3 days after the sexual encounter, I developed a chancre on my glans that was quite large, extremely noticeable, red, pink and orange, very clearly something abnormal and foreign.

There is no question in my mind that I acquired this. It was very noticeably foreign and pathological.

The doctors prescribed me a steroid. The chancre very quickly started changing and quite soon I had redness all underneath my foreskin.

The steroid was prescribed for a short amount of time, maybe 7 days, which cleared the condtion on discontinuation, but it all returned within 5 days. Between then and now (7 years), i have tried a long list of different remedies, mainly all topical. The condition has never responded to fungal treatments including clotrimazole, hydrozole, fluconazole. Various natural rememdies and others such as Suragel, Emuaid and Coconut Oil, Tea Tree Oil - have all done nothing. Salt baths help, but done result in remission, including Dead Sea Salt. The redness is all over underneath the foreskin, and the glans as well. One doctor, gave me incorrect information and told me I would live with this for the rest of my life. So I tried to do that. In a 3 year period, i didn't apply any topicals. In this 3 year period, one day I woke up, and my foreskin had physically noticeably tightened and thinned a bit (still retractable) - but it has never changed since and is still like that today right now. I had at this time about 5 x lesions underneath the foreskin and glans. I went to see my GP and he prescribed topical Mupirocin antibiotic. This antibiotic after a couple of days had an immediate affect on the lesions. I have never seen a topical therapy have this effect on my condition. I did some peer reviewed research and everything I was experiencing was exactly correlating with Zoons Plasma Cell Balanitis. It looked the exact same and at times my lesions could look pink, and sometimes they looked orange too. I fit 100% the diagnosis criteria, as all STI/STD results for everything has been negative. I am perfectly healthy otherwise, i am not immunosuppresed, i dont have diabetes and my PRP protein levels are fine. I have no other skin issues anywhere on my body. The latest research for 2019 for Zoons Cell Plasma Balanitis is that Mupirocin is a good therapy and has contained the condition for other patients, which was co-incidence with me just starting Mupirocin therapy. I had decided however, that ablation with an Erbium YAG Laser was the best option, as it was the only option that had a 100% success rate in 30 patients, most of which had 32 months follow up with no reoccurrence. Topical therapies like Tacrolimus, Pimecrolimus and a range of Steroids, had reoccurrence's left right and centre, at 3months, even 1 year later. Also in the research, the latest research suggests that Zoons Cell Plasma Balanitis is caused by a mycobacteria. With my condition, it has only ever responded to a steroid and an antibiotic and salt baths. I continued Mupirocin therapy 3 times daily for 20 weeks straight, and all 5 x lesions went away. However, during therapy a small red dot appeared and lasted 6 weeks of Mupirocin therapy and still hasnt gone away to this day. This red dot, early on, was rubbing against my foreskin and it was spreading. I was led to believe this was bacterial and it wasn't responding to Mupirocin. So I added Fusidic Acid and also tried Hydrozole again, and it didnt do anything to this red dot (positined alongside the left side of the glans). Please note: all 5 x lesions were quite large and very noticeable.

Since then, we have become aware of irritant dermatitis. This dermatitis was also present when I had the lesions, and you could see a difference between the redness of bacteria and the redness of the irritation. Also, back then, there may have been an immune system response causing plasma cells and inflammation and I believe this subsided a bit after discontinuation of Mupirocin therapy. The irritant dermatitis however is flaring up A LOT. Today it was especially bad. I have been instructed by my dermatologist to use Vaseline and E45 cream too if I want to to keep it moisturised for the irritant dermatitis. He has also prescribed topical Tacrolimus. I started using the E45, as I also thought some of the irritation may be due the extended use of antibiotics. However, I am not convinced that the moisturiser is helping. Today, the redness was especially bad. Sometimes it is really well demarcated where the foreskin stops and its all over the glans and all over underneath the foreskin everywhere. Its very noticeable and very bad, the skin looks so unhealthy. This is about 80% of the time. The other 20%, the skin looks really healthy. So its quite unusual. It obviously needs fixing up and a lot of attention, and this dermatitis has been there for quite a while, and I think was all there when the bacterial lesions were as well. I believe that the bacteria have harmed my skins barrier. My skin is thinned too from use of all these steroids etc. and also, Zoons Cell Plasma has actually been shown to be a 3 stage skin thinning disease. Steroids are no longer an option for me personally. My concern right now is, how do I know if the bacteria are actually all 100% in remission or not? Do I need to wait and see if a lesion starts developing before I know? We did a biopsy, but this was when the skin was looking really good, and it wasnt as bad as it is now, and it only showed irritation dermatitis. But these results dont give me satisfaction that the bacteria have all been eliminated. A culture may or may not return results. I am very sure my condition from the outset, since day 1, has been bacterial. I think the bacteria have harmed my skin barrier and I dont think steroids are helping with restoring that. I dont believe in treating the irritation dermatitis - this is a symptom and I believe I have been in cycles throughout these 7 years. I believe I need to eradicate the bacteria, and my skin will start to restore itself and only then, I can maybe do an odd thing or two to help with restoring my skin barrier. My concern is, having not done the Erbium YAG Laser and ablated all the bacteria and cells - I dont have peace of ming that all the bacteria are gone. Mupirocin in the literature is so new for treating this condition, that they dont have much statistics. All they say is "succesfully contained the condition". There isn't actually mention of recurrence rates or 100% remission. Hence, thats exactly where I am at right now. There are some risks with Erbium YAG, hence I dont know if I need to go ahead with that right now or not, but my gut (through experience) tells me, its not over and Erbium YAG is the way to go (i want to avoid circumsicion). The redness seems to be getting worse from the E45 moisturiser cream. I know that bacteria thrive on moisture and heat, hence I dont know there's a relationship there and this may be indicative. I am trying to treat the irritant deramtitis now to see if that goes away and I'm left with no problems - however the redness is either disliking the moisturiser or doing its idiopathic nature as it has always done - cant pinpoint why its flaring up red everywhere and looking really unhealthy. I wash it just with water only, I use an emollient shower cream (E45). I dont use soap. I do use shampoo and condtioner and face wash, but I am very aware of not getting it down there and do my best and always wash underneath the foreskin after showering. I run just water over it (not too much), then I pat dry with a towel (dont aggravate it). And then, I apply the moisturiser an do this twice per day at the moment. On the second time, I usually wash it with water again (just rinse it over, dont touch it or aggravate it) - because it usually looks like it needs a clean up and it responds well to a bit of water and drying. But, its still flaring up, red as ever for the irritation, and looking like at this moment, its getting worse. I dont have peace of mind that the bacteria are all gone 100% and that small red dot (I dont think is irritant) remains. My dermatologist prescribed me topical Tacrolimus for the irritation twice daily. My thoughts were, to allow my biopsy to heal (needs another week) and I will just apply Vaseline for now twice daily. Once healed, I will start Tacrolimus therapy twice daily and see if the redness I am experiencing responds to the Tacrolimus. I will also see if that small red dot responds too. If the small red dot does not, I may be inclined to call it bacterial still. (In the past, I have got the condition looking like this before and there's always been a small red area that doesnt respond, and that small red area then gets worse and spreads and the whole condition comes back - hence I am skeptical right now, and I believe it to be bacteria forming "biofilm" to gaurd against antibiotics.). I have spoked with the man who conducts the Erbium YAG Laser and he said it will eradicate all bacteria. I hope the Tacrolimus is a good measure for trying to figure out if my bacterial problem is relieved and if this current redness is non bacterial flares, and if it is just irritation dermatitis of some sort. If I feel there may still be bacteria, I may just get the Erbium YAG done all over everywhere for peace of mind, so I know the pathogen in the first place that triggerred all this mess is eradicated, hence I can then treat the dermatitis and restore my skins barrier without it being compromised again. My dermatologist prescribed a steroid but I disagree with using steroids on already thinned skin, and I dont agree that they help restore the skins barrier, and I also dont agree with taking irritant dermatitis steps when we dont know if the bacteria are all eradicated yet, otherwise I will just end up in the same cycle ive been doing, but with risks assocaited with steroid use. There must be another way, and my experience of steroids on the penis skin isn't helpful. Hydrozole, made my skin worse, I had a reaction and it hurt a little bit (hydrocortisone). I think my condition is simple: it is bacteria that started it all, and it has now resulted in a compromised skin barrier which is making me susceptible to more infections and irritant dermatitis. I believe we need to make sure all the bacteria are eradicated as a primary step before any other interventions. I am just unsure on how to do this, given my present situation - how to identify if they are all eradicated, it seems tricky. I will try the Vaseline and Tacrolimus combo therapy for the next few weeks and give it a couple of weeks to measure my outcome and keep an eye on the small red dot (that I believe to be bacterial - or a "kissing lesion"). If no response, I will conclude bacterial as likely. If small red dot does not respond, I may conclude bacterial is likely. I am curious to see if the current redness (which shows up as red all over the glans and all over underneath the foreskin, everywhere, even on the edge of the glans) - curious to see if it responds to Tacrolimus topical, i.e. is it irritant - or is it bacterial as well? I will see how we go and what I an conclude from this. I made the decision to get it all ablated with the laser, but due to financial constraints at the time, I went down the topical route (the exact route I wanted to avoid). Now dermatologists are prescribing me the very things I wanted to avoid (steroids and immunosuppresent topicals). I wish I went with the laser before doing the topicals, as these topicals I dont think have helped with restoring my skins barrier function and the steroid certainly had an affect on my skins thinness - which may make me even more susceptible to irritation now too. But hopefully it hasnt thinned too far, my foreskin is still retractable fine but visually thinner and very tight on erection and it will need stretching after all of this is over. But its never too late for the laser. Once I've concluded my current position, I will get the laser if there is even one confirmation sign of bacteria. Antibiotics don't always kill bacteria - they can develop biofilm and resistance is actually out there. I have been advised that I can also try betadine with swabs and chlorhexidine swabs too. So i may try these before I make the trip to another country for the laser. Having said all of that, my current position is still very disoncerting - the redness is so red at the moment and it looks so unhealthy (my glans and foreskin skin) at times. It's surpising to me that I've seen 20 or so GP's, dermatologists and a urologist - some of which on many multiple occasions - been to a sexual healthy centre, spoken with people online and done all my research - and this condition, 7 years later is still prevailing. I read someone on here talking about the cycles and the skin barrier and my experience correlates with this. I hope I can restore my penis and I hope the skin thinning hasnt gone to far - but I dont think it has, but I wont risk any more steroids down there ever again. I feel at times that dermatologists are slowing me down and that this condition is beyond them. Sometimes I feel like they aren't 100% up to date and that my experience with some things, does not correlate with what they think. And its that information gap, that makes me believe that whats out there isn't right, and doesnt always help in this situation. I am 99.9999% sure I acquired bacteria sexually and is destroyed my skin barrier function, and I dont believe in addressing my symptoms, I believe in eradicating all the bacteria before addressing the symptoms, otherwise we wont get anywhere. Any comments and help would be SO greatly appreciated. Thanks for your help in advance and time listening to my case. I might try get some photos up on here too! Thank you!

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