What is the treatment for swelling of the penis foreskin?

Treatment for Swelling of Penis Foreskin

The first-line treatment for swelling of the penis foreskin is application of a topical steroid cream such as hydrocortisone or triamcinolone, applied twice daily for 4 weeks, combined with gentle retraction and proper hygiene.

Diagnosis and Assessment

Before initiating treatment, it's important to determine the underlying cause of foreskin swelling:

• Phimosis: Inability to retract the foreskin over the glans
• Paraphimosis: Foreskin retracted behind the glans and cannot be returned to normal position (medical emergency)
• Balanitis/Balanoposthitis: Inflammation of the glans/foreskin
• Lichen sclerosus: Chronic inflammatory condition causing white patches and tightening
• Edema: Generalized swelling due to fluid retention

Treatment Algorithm

1. For Phimosis (Non-Emergency)

• First-line: Topical steroid cream (0.05% betamethasone or 0.1% triamcinolone) applied to the tight preputial ring twice daily for 4-6 weeks 1

  • Success rates of 67-95% reported with topical steroids
  • Combine with gentle retraction and proper hygiene
  • Reassess after 6 weeks

• If unsuccessful after 4-6 weeks:

  • Consider extending treatment for another 4 weeks
  • Consider surgical options if medical management fails

2. For Paraphimosis (Emergency)

Paraphimosis requires immediate intervention to prevent glans necrosis:

1. Manual reduction after reducing edema:

   • Apply ice packs to reduce swelling
   • Compress the glans to squeeze out edematous fluid 2
   • Gently push the glans back through the constricting band while pulling the foreskin forward

2. If manual reduction fails:

   • Consider needle puncture technique: using an 18-gauge needle to puncture the edematous foreskin at multiple sites, followed by gentle compression 3
   • If still unsuccessful, surgical intervention (dorsal slit) may be required

3. For Balanitis/Balanoposthitis

• Mild cases: Improved hygiene and topical hydrocortisone cream applied 3-4 times daily 4
• If infection suspected: Add appropriate antimicrobial therapy based on likely pathogen:
  • Bacterial: Antibacterial wash or cream
  • Fungal: Antifungal cream
  • Maintain good hygiene with gentle cleansing

4. For Lichen Sclerosus

• First-line: Potent topical corticosteroid applied once or twice daily for 1-3 months 5
• Maintenance: After initial treatment, reduce frequency to 1-2 times weekly
• Follow-up: Regular monitoring for disease progression or malignant transformation

Special Considerations

• Children under 2 years: Phimosis is physiological; avoid forceful retraction and consult a doctor before applying topical steroids 4
• Buried penis: Poor response to topical steroids; may require surgical intervention 6
• Balanitis xerotica obliterans (BXO): Severe cases may not respond to topical steroids and require surgery 1
• Circumcision: Consider only after failure of conservative management or in cases of recurrent problems

Complications and Pitfalls

• Delayed treatment of paraphimosis can lead to tissue necrosis and should be treated as an emergency 2
• Forceful retraction in children can cause micro-tears, scarring, and worsen phimosis
• Overuse of topical steroids can cause skin atrophy and systemic absorption
• Circumcision results in permanent loss of foreskin sensitivity and should be considered carefully 7

Follow-up

• Reassess after 4-6 weeks of topical steroid treatment
• If improvement is seen but resolution is incomplete, continue treatment for another 4 weeks
• If no improvement or worsening occurs, consider referral to a urologist for evaluation for surgical options

Remember that most cases of foreskin swelling can be successfully managed with conservative measures, and circumcision should be reserved for cases that fail medical management.