From the Guidelines
The treatment for an open area on the penis should prioritize immediate medical evaluation to determine the cause, as conditions like Fournier’s gangrene require prompt and aggressive treatment, including surgical debridement and antibiotic therapy, to prevent severe morbidity and mortality 1. When considering the management of an open area on the penis, it's crucial to differentiate between minor injuries and more severe conditions such as Fournier’s gangrene, a severe type of necrotizing soft-tissue infection involving the genital area and perineum. The approach to treatment varies significantly based on the diagnosis:
- For minor cuts or abrasions, gentle washing with mild soap and water, pat drying, and applying an antibiotic ointment like bacitracin or Neosporin twice daily until healed is recommended.
- For suspected sexually transmitted infections causing ulcers, such as herpes, syphilis, or chancroid, prompt medical evaluation is essential for prescription medications like acyclovir (400mg three times daily for 7-10 days for herpes) or appropriate antibiotics.
- In cases of Fournier’s gangrene, early and extensive initial surgical debridement improves survival, alongside prompt appropriate antibiotic therapy and hemodynamic support 1. The use of fecal diversion, such as colostomy or fecal diversion tubes with negative pressure wound therapy, may be considered in cases with fecal contamination to reduce bacterial load and control infection. Given the potential for severe complications and the importance of timely intervention, any open area on the penis accompanied by pain, discharge, fever, spreading redness, or failure to improve within a few days should prompt immediate medical attention. Proper diagnosis is crucial as some conditions require specific treatments beyond general wound care, and the rich blood supply of the penis skin typically promotes good healing when properly treated.
From the Research
Treatment Options for Open Area on Penis
The treatment for an open area on the penis depends on the underlying cause of the condition. Some possible causes and their corresponding treatments are:
- Necrotizing granulomatous inflammation: Treatment with oral corticosteroids may be effective in limiting the inflammatory process, but in some cases, surgery such as glansectomy and split-skin graft reconstruction may be necessary 2.
- Penile paraffinoma and ulcers: Treatment may involve intravenous antibiotic therapy combined with local therapy 3.
- Mycotic infections: Superficial infections of the penis can be treated with local antifungal treatment, while systemic treatment is recommended for widespread dermatophytic infection, candidosis, or systemic mycosis 4.
- Calciphylaxis cutis: The treatment for this condition is not specified in the available evidence, but the diagnosis is made through histopathological and radiological examination 5.
- Tuberculosis of the glans penis: Treatment with category I anti-tubercular treatment can be effective in resolving the lesions 6.
Importance of Diagnosis
It is essential to perform and interpret penile biopsies before undertaking potentially mutilating definitive surgery to determine the underlying cause of the open area on the penis 2. A differential diagnosis of penile ulceration should be considered, including conditions such as necrotizing granulomatous inflammation, penile paraffinoma, mycotic infections, calciphylaxis cutis, and tuberculosis of the glans penis 2, 3, 4, 5, 6.