What are dry fissures on the penis called and what is the appropriate initial treatment while awaiting STI screening results?

Dry Fissuring Cracks on the Penis: Diagnosis and Treatment

The dry fissuring cracks you're describing are most likely either irritant contact dermatitis (from excessive hygiene or friction), candidal balanitis, or possibly lichen sclerosus, and initial treatment should include a topical antifungal cream (clotrimazole 1% twice daily) combined with a mild topical corticosteroid while awaiting your STI screening results. 1, 2, 3

Understanding the Condition

The clinical term for inflammation and fissuring of the penile skin depends on the specific cause:

• Balanitis refers to inflammation of the glans (head) of the penis 2, 4
• Fissuring or cracking can occur with several conditions including candidal infection, irritant dermatitis, or chronic inflammatory conditions 2, 3
• In uncircumcised men, moisture and maceration under the foreskin create an environment prone to fungal overgrowth and irritation 2, 5

Most Likely Causes in Your Situation

Candidal (Yeast) Balanitis

• Candida albicans is the most frequent fungal cause of penile fissuring and inflammation, particularly in uncircumcised men 5
• Presents with redness, fissuring, and sometimes white discharge or cottage cheese-like material 2, 5
• Sexual transmission is common, so your partner may need evaluation 1, 5

Irritant Contact Dermatitis

• "Over-treatment balanitis" from excessive washing or harsh soaps is a common cause of dry, cracked penile skin 4
• Results from persistent moisture, friction, or chemical irritation 2, 3

Other Considerations

• Lichen sclerosus presents as white, atrophic patches with a "cellophane-like texture" and can cause fissuring, though this is typically more chronic 3
• Psoriasis can affect the penis but usually lacks the typical silvery scale due to moisture 2, 3

Initial Treatment Approach

Immediate Management (While Awaiting STI Results)

Topical antifungal therapy:

• Apply clotrimazole 1% cream twice daily for 7-14 days 1, 5
• Alternative options include miconazole 2% cream 1
• Most superficial penile fungal infections respond well to topical treatment 5

Adjunctive measures:

• Stop using harsh soaps or excessive washing 4
• Keep the area clean and dry 2
• If uncircumcised, gently retract foreskin daily for cleaning and ensure it's thoroughly dried 2
• Consider a mild topical corticosteroid (hydrocortisone 1%) if significant inflammation is present, but use cautiously and briefly 3

Important Caveats

Do not assume this is purely fungal without considering:

• Your STI screen is appropriate and necessary, as herpes simplex virus can cause genital ulceration and fissuring 2
• If symptoms persist after 2 weeks of antifungal treatment, you need re-evaluation and possibly biopsy 1, 3
• Biopsy is indicated if neoplasm cannot be excluded or if the lesion has an atypical appearance (irregular borders, induration, bleeding) 3

When to Seek Urgent Re-evaluation

Return immediately if you develop:

• Spreading redness or warmth suggesting bacterial superinfection 2
• Purulent discharge 2
• Systemic symptoms like fever 2
• Worsening despite treatment 1

Partner Management

• If candidal balanitis is confirmed, your sexual partner should be evaluated, as male partners may benefit from topical antifungal treatment to relieve symptoms and prevent reinfection 1
• Avoid sexual activity until both you and your partner complete treatment 1

Follow-Up

• Return for follow-up if symptoms persist or recur within 2 months 1
• Complete your STI screening as planned 2
• If no improvement after appropriate antifungal therapy, consider alternative diagnoses including lichen sclerosus, psoriasis, or rarely, carcinoma in situ 3