What are the treatment options for an itchy penis?

Treatment of Penile Itching

Start with 1% hydrocortisone ointment applied to the affected area 3-4 times daily for a maximum of 2 weeks, combined with identification and treatment of the underlying cause. 1, 2

Initial Assessment and Diagnosis

Before initiating treatment, determine the underlying etiology by examining for:

• Fungal infections (most common): Look for erythema, white plaques, satellite lesions, or scaling on the glans or prepuce—Candida balanitis is the most frequent mycotic infection of the penis and is primarily sexually transmitted 3, 4
• Dermatophyte infections: Check for extension from tinea cruris, particularly in younger patients or those wearing occlusive undergarments 5
• Contact dermatitis: Ask specifically about condoms, lubricants, soaps, detergents, or feminine hygiene products used by partners 4, 6
• Lichen sclerosus: Examine for atrophic white patches on glans and foreskin, which may cause phimosis 7, 4
• Psoriasis or lichen planus: Inspect entire body for characteristic lesions; genital psoriasis typically lacks typical scaling due to moisture 4, 6
• Parasitic infections: Consider scabies (transmitted by skin-to-skin contact) or pediculosis pubis 7, 4
• Sexually transmitted infections: If urethral symptoms present, test for gonorrhea and chlamydia 7

First-Line Treatment Algorithm

For Non-Specific Inflammatory Pruritus:

• Apply 1% hydrocortisone ointment 3-4 times daily for 2 weeks maximum to prevent skin atrophy 1, 2
• Clean the affected area with mild soap and warm water before application, then gently dry by patting 2
• Critical pitfall: Never extend topical steroid use beyond 2 weeks due to risk of skin atrophy and other adverse effects 1

Adjunctive Symptomatic Relief:

• Non-sedating antihistamines: Loratadine 10mg daily or fexofenadine 180mg daily for daytime relief without sedation 8
• Menthol preparations: Provide symptomatic relief for mild to moderate pruritus 1, 8
• Topical doxepin: Can be considered but must be strictly limited to 8 days maximum, covering less than 10% body surface area, not exceeding 12g daily 1, 8

Cause-Specific Treatment

If Candida Balanitis Identified:

• Local antifungal treatment is first-line for superficial infections 3
• Consider sexual transmission and treat partner simultaneously 3
• Address provocative factors: diabetes, immunosuppression, poor hygiene 3, 9
• Systemic antifungal treatment recommended for widespread or recurrent candidosis 3

If Dermatophyte Infection Present:

• Topical antifungal agents for localized penile involvement 3
• Systemic antifungal treatment recommended for widespread dermatophytic infection 3
• Address occlusive clothing or moisture-promoting factors 5

If Contact Dermatitis Suspected:

• Eliminate the offending agent: Stop use of condoms (or switch to different material), lubricants, soaps, or partner's hygiene products 4, 6
• Continue with topical corticosteroid as above 1
• Keep the glans penis dry and ensure balanced genital hygiene 9

If Lichen Sclerosus Diagnosed:

• Potent topical corticosteroid is first-line treatment for male genital lichen sclerosus 7
• Monitor for phimosis or meatal stenosis development 7, 4
• Circumcision may be required if scarring causes structural changes unresponsive to medical therapy 7

If Parasitic Infection (Scabies/Pediculosis):

• For pediculosis pubis: Permethrin 1% cream rinse applied to affected areas and washed off after 10 minutes 7
• For scabies: Permethrin cream 5% applied to all areas from neck down 7
• Treat sexual partners within the last month 7
• Decontaminate bedding and clothing by machine washing/drying with heat 7

When to Escalate Care

Refer to dermatology or urology if:

• No improvement after 2 weeks of appropriate first-line therapy 1
• Suspicion of lichen sclerosus, plasma cell balanitis, or premalignant lesions requiring biopsy 7, 4
• Recurrent infections despite treatment and partner management 3
• Development of phimosis or urethral involvement 7, 9
• As last resort: Therapeutic circumcision can be considered for most forms of chronic balanitis unresponsive to medical management 9

Critical Management Principles

• Maintain genital hygiene balance: Avoid both excessive washing (irritant dermatitis) and inadequate hygiene (infection risk) 9
• Keep the area dry: Moisture and maceration worsen most penile dermatoses 9, 4
• Always consider sexual transmission: Evaluate and treat partners for infectious causes 7, 3
• Avoid sedating antihistamines: Use only non-sedating H1 antagonists due to dementia risk with sedating agents 8