Differential Diagnosis for 56 YOM with Cracked Erythematous Foreskin and White Coating at Glands

• Single Most Likely Diagnosis
  • Balanitis: This condition is characterized by inflammation of the glans penis and is often associated with a cracked, erythematous foreskin and a white coating, which could be due to a fungal infection like candidiasis or a bacterial infection. The presentation is classic for balanitis, especially in uncircumcised males.
• Other Likely Diagnoses
  • Candidiasis (Yeast Infection): A common cause of balanitis, especially in diabetic or immunocompromised patients. The white coating is suggestive of a yeast infection.
  • Bacterial Balanitis: Caused by bacteria such as streptococci or staphylococci, it can present with similar symptoms, including erythema and discharge.
  • Lichen Sclerosus: A chronic inflammatory skin condition that can cause the foreskin to become thin, wrinkled, and sometimes erythematous, though it less commonly presents with a white coating.
• Do Not Miss Diagnoses
  • Squamous Cell Carcinoma: Although less likely, any persistent or unusual lesion on the penis, especially in older men, warrants consideration of malignancy to avoid delayed diagnosis.
  • Syphilis: Primary syphilis can present with a chancre on the penis, which might be accompanied by erythema and could be mistaken for other conditions. It's crucial to consider syphilis due to its serious complications if left untreated.
• Rare Diagnoses
  • Pemphigus: An autoimmune disease that can cause blistering of the skin and mucous membranes, including the genital area, though it's much less common.
  • Fixed Drug Eruption: A condition caused by an adverse reaction to medication, which can cause lesions on the genital area, including the foreskin, but it's relatively rare and usually has a distinct history of medication use preceding the eruption.