Differential Diagnosis for Tight Foreskin with Skin Splits and Rash

• Single Most Likely Diagnosis

  • Phimosis: This condition is characterized by a tight foreskin that cannot be fully retracted over the glans penis. The tightness can lead to skin splits, especially during activities like showering, and can also cause irritation and rashes underneath due to the accumulation of smegma and poor hygiene.

• Other Likely Diagnoses

  • Balanitis: An inflammation of the glans penis, which can be caused by poor hygiene, infections (bacterial, fungal, or viral), or irritants. Symptoms include redness, swelling, and rash on the glans, and sometimes under the foreskin.
  • Eczema/Dermatitis: Conditions that can cause skin rash and irritation. In the context of a tight foreskin, moisture accumulation can exacerbate eczema or dermatitis, leading to symptoms under the foreskin.
  • Lichen Sclerosus: A chronic inflammatory skin condition that can affect the genital area, causing thinning of the skin, itching, and sometimes tearing of the skin.

• Do Not Miss Diagnoses

  • Cancer (e.g., Squamous Cell Carcinoma): Although rare, penile cancer can present with skin changes, ulcers, or rash. A tight foreskin (phimosis) is a risk factor for penile cancer, partly due to poor hygiene and chronic irritation.
  • Infections (e.g., Cellulitis, Abscess): Bacterial infections can cause severe inflammation, redness, swelling, and sometimes skin splits. These conditions require prompt medical attention to prevent spread of infection.

• Rare Diagnoses

  • Keratinizing Disorders: Conditions like ichthyosis or other keratinizing disorders can cause skin dryness and irritation, potentially worsening under a tight foreskin.
  • Autoimmune Conditions: Certain autoimmune diseases can cause skin manifestations, including in the genital area, though these would be less common causes of the described symptoms.