Friday, February 23, 2007

Rash and dysuria


48y, fork-lift operator, h/o tobacco and alcohol abuse, f/h of CAD and DM, recently diagnosed with HTN, comes in with dysuria, redness and irritation over the glans penis and discomfort on trying to retract the foreskin. These symptoms started about 4 days ago. He has been in a monogamous relationship and hasn't been sexualy active for over 6 months. He has been on HCTZ 25mg for about 6 weeks and was recently prescribed viagra for ED. On exam, the glans penis appears very erythematous, the prepuce non-circumcised, erythematous, with fissuring. Urine analysis showed 1+ protein and approximately 250mg% of glucose without any RBC or WBC. Random blood sugar was 201. His last meal was about 3 hours ago.
Which of the following treatments is most likely to be successful?

1. Topical Clotrimazole 1% bid and wash with warm water 4-5 times/ day- ANSWER.
2. Topical Triamcinolone 0.1% bid.
3. Stop HCTZ and Viagra- this is possibly fixed drug eruption
4. Cefixime 400mg po x 1 and Doxycycline 100mg bid x 7 days
5. Pimecrolimus 1% topical bid