Differential Diagnosis for Penile Pain and Itchiness
- Single most likely diagnosis
- Irritant contact dermatitis: The patient's symptoms worsened after using clotrimazole cream TID for 1 week, suggesting a possible irritant reaction to the cream. The improvement in scrotum itchiness but worsening of penile symptoms supports this diagnosis.
- Other Likely diagnoses
- Allergic contact dermatitis: Similar to irritant contact dermatitis, an allergic reaction to the clotrimazole cream or other substances could be causing the patient's symptoms.
- Residual or recurrent candida balanitis: Although the patient was initially treated for candida balanitis and showed improvement, it's possible that the infection was not fully cleared or has recurred.
- Lichen sclerosis: A chronic inflammatory skin condition that can cause itching, redness, and swelling of the genital area.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Squamous cell carcinoma: A type of skin cancer that can present with itching, redness, and swelling of the genital area. Although rare, it's essential to consider this diagnosis to avoid delayed treatment.
- Fixed drug eruption: A rare but potentially severe reaction to certain medications, including antifungals like clotrimazole, which can cause skin lesions and other symptoms.
- Rare diagnoses
- Zoon's balanitis: A rare, chronic inflammatory condition that affects the glans penis and can cause itching, redness, and swelling.
- Psoriasis: Although more commonly associated with skin lesions on other parts of the body, psoriasis can occasionally affect the genital area and cause itching and redness.
- Erythrasma: A bacterial infection that can cause itching, redness, and swelling of the genital area, particularly in the folds of the skin.