Treatment of Penile Excoriation
For traumatic excoriation injuries to the penis, immediate wound care with topical antibiotic ointment (bacitracin) is the first-line approach for minor injuries, while severe cases with total skin loss require urgent surgical management with split-thickness skin grafting. 1, 2
Initial Assessment and Wound Classification
The severity of penile excoriation determines the treatment pathway:
- Minor excoriations (superficial abrasions, small cuts, or scrapes) can be managed conservatively with local wound care 1
- Severe excoriations (total or near-total skin loss) require immediate surgical consultation and are considered a "postponed emergency" requiring intervention within 8-12 hours 2
Treatment Algorithm
For Minor Excoriations (First-Line Management)
Topical wound care:
- Clean the affected area thoroughly 1
- Apply bacitracin ointment (amount equal to fingertip surface area) 1-3 times daily to prevent infection and provide pain relief 1
- May cover with sterile bandage 1
- Monitor for signs of infection (increased redness, warmth, purulent drainage) 1
Important caveat: Do not use bacitracin in children under 2 years without consulting a physician 1
For Severe Excoriations (Surgical Management)
When total or near-total penile skin loss occurs:
Immediate measures (within 8-12 hours):
- Perform standard wound toilet 2
- Insert urinary catheter 2
- Consider temporary placement of penis in subcutaneous abdominal tunnel 2
Definitive reconstruction:
- Split-thickness skin grafting is the gold standard for achieving new skin coverage 2
- Native penile skin coverage (if any viable tissue remains) provides superior cosmetic and functional outcomes compared to flaps or grafts from other sites 3
- If testicles are exposed, create a thigh pouch to prevent thermal damage 2
Common Pitfalls to Avoid
- Delayed surgical referral: Severe excoriations require urgent evaluation within hours, not days, to optimize healing and prevent infection 2
- Inadequate wound cleaning: Thorough debridement and cleaning are essential before any reconstruction to prevent infection 2
- Overlooking urinary management: Catheterization is necessary in severe cases to prevent urine contamination of wounds 2
When to Consider Alternative Diagnoses
If the excoriation appears to be self-induced or repetitive without clear traumatic cause, consider excoriation (skin picking) disorder, which requires psychiatric evaluation and treatment with SSRIs, behavioral therapy, or alternative approaches like N-acetylcysteine 4, 5, 6