Treatment of Skin Fissuring and Cracking of the Glans Penis
For skin fissuring and cracking of the glans penis, immediate wound care with copious irrigation, topical antibiotic ointment, and occlusive dressing is the first-line treatment, followed by moisture maintenance with petroleum jelly and daily foreskin retraction checks in uncircumcised males to prevent adhesions. 1
Immediate Wound Management
The cornerstone of treatment involves thorough wound cleansing and moisture maintenance:
Irrigate the affected area with large volumes (100-1000 mL) of warm or room temperature tap water to remove debris and foreign matter, as tap water is as effective as or superior to sterile saline in reducing infection rates 1
Apply topical antibiotic ointment after cleaning to maintain wound moisture and prevent bacterial infection; options include silver sulfadiazine, bacitracin, or other topical antibiotics 1, 2
Cover with a clean occlusive dressing to maintain moisture and prevent drying, which significantly shortens healing times compared to leaving wounds exposed 1
Specific Care for Genital Skin Fissures
Additional measures are critical for optimal healing in this anatomical location:
Apply white soft paraffin (petroleum jelly) to the affected area every 4 hours during the acute healing phase to maintain moisture and reduce friction 1
In uncircumcised males, check daily that the foreskin can be retracted over the glans to prevent adhesion formation during healing 1
Consider topical corticosteroid (betamethasone 0.05% or clobetasol propionate 0.05% ointment) once daily to non-eroded areas if significant inflammation is present, as this reduces inflammation and may prevent scarring 1, 3
Identifying the Underlying Cause
While treating the acute fissures, consider common etiologies:
Candidal balanitis is the most frequent mycotic infection of the penis and presents with fissuring, particularly in sexually active individuals 4
Poor hygiene and chronic moisture are responsible for most cases of inflammatory penile conditions that lead to fissuring 5
Lichen sclerosus presents as atrophic white patches and is a common cause of fissuring and phimosis in uncircumcised men 6
Contact dermatitis (allergic or irritant) may result from condoms, lubricants, or persistent moisture and maceration 6
When to Escalate Care
Specific clinical scenarios require further medical evaluation:
If signs of infection develop (increased redness, warmth, purulent discharge, or fever), further medical attention is necessary 1
If the wound fails to heal within 1-2 weeks despite appropriate care, further evaluation is required 1
If scarring leads to phimosis (inability to retract foreskin) after healing, topical steroid therapy for 4-6 weeks or surgical intervention may be necessary 1, 3, 5
If underlying lichen sclerosus is suspected, biopsy may be required as this condition has higher likelihood of requiring surgical intervention and is less responsive to conservative measures 3
Critical Pitfalls to Avoid
Common errors that delay healing or worsen outcomes:
Never use dry dressings alone, as occlusive/moist dressings significantly improve healing compared to leaving wounds exposed to air 1
Never apply topical corticosteroids to open wounds or erosions; they should only be used on intact inflamed skin 1
Never use cold water for irrigation when warm water is available, as it causes unnecessary discomfort 1
Never ignore persistent symptoms, as failure to heal may indicate underlying pathology like lichen sclerosus, chronic candidal infection, or premalignant lesions requiring biopsy 1, 6