Red shiny plaques or patches on the genital skin usually
bring the patient fairly quickly to the doctor. They can be seen in squamous
cell carcinoma but are also a feature of psoriasis , lichen sclerosus, lichen
planus and candida. Candida should cause a smell and slight discharge but the
other diseases are difficult to tell apart without a biopsy. Psoriasis and
candida will both respond to a cream containing hydrocortisone and clotrimazole
twice daily for a couple of weeks but if there is no response a biopsy is
necessary. Sometimes the biopsy is reported as a Zoon’s balanitis. This is a
curious reaction pattern in genital skin where the skin is infiltrated with
lots of plasma cells in the dermis. It may be secondary to infection such as
candida or chronic irritation and respond to the steroid clotrimazole mixture
or a slightly stronger steroid cream. Persistent red plaques should always be
biopsied to exclude a squamous cell carcinoma in situ.
