From the Guidelines
Dry, cracked foreskin typically indicates a condition that may require medical evaluation and management, prioritizing morbidity, mortality, and quality of life as outcomes. For immediate relief, gently clean the area daily with warm water only (no soap), and apply a mild, fragrance-free moisturizer like petroleum jelly or a prescribed 1% hydrocortisone cream twice daily for 7-10 days 1. If symptoms persist or worsen, further evaluation is necessary to determine the underlying cause, which could include lichen sclerosus, a condition that may require potent topical corticosteroids or even surgical intervention in cases of severe phimosis or meatal stenosis 1. Key considerations in management include:
- Ensuring proper diagnosis through biopsy if necessary to rule out other conditions like lichen planus or genital intraepithelial neoplasia 1
- Addressing potential complications such as urinary symptoms, which may necessitate referral to a urologist for assessment of urethral involvement 1
- Considering surgical options for patients with persistent disease unresponsive to topical steroids, including circumcision, which may be curative for some patients but requires careful follow-up due to the risk of disease recurrence or malignant change 1
- Providing patient education on symptoms of disease relapse and potential malignant changes, emphasizing the importance of long-term follow-up for patients with a history of lichen sclerosus 1. Given the potential for significant morbidity and impact on quality of life, a thorough medical evaluation is essential for any patient presenting with dry, cracked foreskin that does not respond to initial conservative management 1.