How can I treat eczema on my penis?

There are a number of skin conditions that can affect the penis, for example allergic contact dermatitis and eczema, with the most common form being atopic eczema (or atopic dermatitis).

Claire Harris, registered nurse, in our 24/7 health support team for members, takes a look at what eczema is, what can aggravate it and what possible treatment options might be.

What is eczema and how does it affect the penis?

Eczema is a chronic inflammatory skin condition characterized by red, itchy, and inflamed skin. It can occur anywhere on the body, including sensitive areas like the penis. The exact cause of eczema is not fully understood, but it is believed to involve a combination of genetic, environmental, and immune system factors.

Unfortunately, there is no cure for eczema¹, instead it’s about avoiding allergens and preventing the skin from becoming dry by using medical moisturisers. Different people react to different allergens, so you need to find out what you are allergic to and try your best to avoid it.

The skin is made up of three layers:

• the top layer epidermis (top layer),
• dermis (middle layer),
• and subcutaneous layer the (bottom layer).

Normally the skin cells in the upper (epidermal) layer are tightly packed so they help create a barrier. With eczema, the layers do not provide the normal barrier function which can lead to exposure to the elements and therefore produce inflammation.

During a flare up of eczema the skin becomes red, inflamed and itchy. This inflammation process can lead to swelling of the skin which can produce tiny blisters, these blisters can then rupture.

Inflamed skin can be very itchy and prolonged rubbing and scratching leads to thickening of the epidermis making the skin appear thick and leathery. Sometimes inflamed skin can become infected especially if it is around the penis, where there are more folds and creases. There is also an increased exposure to bacteria, which can thrive in a warm environment.

What can aggravate eczema of the penis?

Eczema of the penis can be aggravated by various factors, including:

1. Irritants – Certain soaps, detergents, lotions, or personal care products that contain fragrances, alcohol, or harsh chemicals can irritate sensitive skin.
2. Moisture – Excess moisture from sweating or inadequate drying after bathing can contribute to irritation and exacerbate eczema.
3. Friction – Activities that cause friction, such as vigorous sexual activity or tight clothing², can irritate the skin and worsen symptoms.
4. Allergens – Allergens like latex (found in some condoms), certain fabrics, or even specific foods may trigger flare-ups in some individuals.
5. Infections – Either bacterial or viral.
6. Stress – Emotional stress can impact the immune system and may trigger or worsen eczema symptoms.
7. Temperature and humidity changes – Extreme changes in temperature, humidity, or exposure to hot water can also aggravate eczema.
8. Hormonal changes – Fluctuations in hormones can sometimes lead to changes in skin conditions, including eczema.

Identifying and avoiding specific triggers can help you manage and reduce flare-ups. This may not be an easy matter. Inflamed areas of skin tend to flare up from time-to-time and then tend to settle down, the severity and duration of flare-ups also varies from person-to-person.

If you are experiencing eczema on the penis, it is essential to consult a healthcare professional for a proper diagnosis, personalised advice and treatment options.

How can you treat eczema of the penis?

Treating eczema of the penis typically involves a combination of self-care measures and medical treatments. Here are some general approaches, but it is crucial to consult a healthcare professional for a tailored treatment plan:

1) Hygiene

It is important to keep the genital area clean. The penis needs to be washed once or twice a day, after fully retracting the foreskin, if uncircumcised. Instead of using soap, washing with a cream such as an emulsifying ointment³, sometimes with the addition of an antibacterial ingredient, can be helpful.

2) Moisturisers

Use fragrance-free, hypoallergenic moisturizers regularly to keep the skin hydrated and reduce dryness. Applying moisturizer after bathing can be particularly effective.

3) Topical corticosteroids

A healthcare provider may prescribe mild to moderate topical corticosteroids to reduce inflammation and itching. It is important to use these as directed and not to overuse them, especially on sensitive skin. 

4) Avoid irritants

Identify and avoid products that may irritate the skin, such as scented soaps, lotions, or laundry detergents. Opt, instead, for gentle, fragrance-free options.

5) Cool compresses

Applying a cool, damp cloth to the affected area can help soothe itching and discomfort.

6) Antihistamines

Over-the-counter antihistamines may help alleviate itching, especially if it disrupts sleep.

7) Loose clothing

Wear loose-fitting 100% cotton, bamboo or silk underwear and clothing to reduce friction and irritation in the genital area.

8) Avoid scratching

Keeping nails short and wearing gloves at night can help prevent scratching and further irritation.

9) Lifestyle modifications

Managing stress through techniques such as mindfulness, yoga, or exercise may help reduce flare-ups. If your symptoms persist or worsen, it's essential to seek medical advice from a healthcare professional, who may recommend additional treatments or investigate other underlying conditions.

Medical moisturisers/emollients

Emollients are an important part of managing eczema, including eczema of the penis, as they help to hydrate the skin and create a protective barrier. When choosing emollients for this sensitive area, it is important to select products that are gentle and free from fragrances, dyes, and other potential irritants.

Here are some types of emollients that may be suitable:

1. Creams and ointments – thicker formulations like creams or ointments often provide better hydration than lotions. Generally, ointments are stickier than creams and they stay on longer, so help to maintain moisture in the skin for longer.
2. Hydrating lotions – lightweight, hydrating lotions specifically formulated for sensitive skin can also be used, but ensure they are fragrance-free and hypoallergenic.
3. Specialised eczema creams – some emollients are formulated specifically for eczema and may contain additional soothing ingredients like colloidal oatmeal or ceramides.
4. Barrier creams – these can help protect the skin from irritants and moisture loss. Products that contain zinc oxide may be particularly beneficial.

When using emollients, apply them liberally to the affected area, especially after bathing or washing, to lock in moisture. Always do a patch test when trying a new product to ensure there is no adverse reaction and consult a healthcare professional for personalised recommendations that suit your specific condition.

During flare-ups

Applying steroid creams help to reduce the inflammation.

• Hydrocortisone⁴ is a mild strength steroid. It can be used with or without the addition of anti-bacterial or anti-yeast agents for mild attacks or when the inflammation is reduced after a severe attack. They can be used for short periods intermittently.
• Eumovate⁵ is a moderately potent steroid which is useful for reducing severe attacks.
• Alternatively for a very severe flare-up your doctor may prescribe an even stronger steroid cream, such as betamethasone.⁶

It is usual to start using the mild strength steroid such as Hydrocortisone and then go on to using the more potent strength steroid such as Eumovate if the eczema has not cleared.

It is important to use the right amount of cream prescribed. Topical steroids are generally used once a day, or as prescribed, and a 30g tube should normally last at least 3 months.⁷

Steroid creams or ointments should be spread thinly on the inflamed skin only using a small amount of the cream or ointment once or twice daily. If combined topical steroids and antibiotic creams are prescribed for infection, they should be used for a maximum of 14 days, after which time you should return to plain topical steroids if the eczema is still flaring.⁷

Once the eczema has cleared it is important to continue to keep the area clean, dry and moisturised daily.

Long-term, persistent use of steroid creams can lead to thinning skin and other side effects. Normal regular use during flare up is unlikely to lead to thinning skin. If the skin does thin, simply stop using it and inform your GP.

Eczema on the penis can be treated and flare-ups can be controlled but it is important to avoid any perfumed products that may cause irritation, and to ensure you wear loose-fitting clothing to help any irritation. If you are concerned about symptoms or need some advice on which creams or ointments to use, then speak with a healthcare professional, for example, your GP or local registered pharmacist.

References

1. Eczema – NHS
2. Male genital eczema – National Eczema Society
3. Emollients – NHS
4. About hydrocortisone for skin – NHS
5. Eumovate – NHS
6. Betamethasone for skin – NHS
7. Treatment – National Eczema Society