Cracked foreskin presents with mild burning, itching, swelling and red patches, and with tight foreskin (phimosis)
Cracks or fissures on the foreskin may be due to Inflammatory conditions of the foreskin (called posthitis) or head of the penis (balanitis) or both (balanoposthitis). These cracks could be painful and can be associated with fungal or bacterial infection, lichen sclerosus (BXO), and tight foreskin (phimosis and Paraphimosis).
Fungal infections are usually responsible, most commonly involving the yeast called Candida albicans, which is associated with a bacterial infection. Foreskin yeast infection is usually called “candidiasis” or “thrush” which is not common in healthy individuals, but it is common in cancer or immunocompromised and in diabetic individuals.
Bacterial infections, especially Streptococcus organisms, are the second most common cause of balanitis. STIs need to be excluded by the sexual health clinic. Most common STIs are due to Chlamydia trachomatis, genital mycoplasmas, and Neisseria gonorrhoeae. These can produce cracks and red foreskin.
Poor hygiene due to a tight foreskin can cause cracks on the foreskin and irritant balanitis.
Diabetic patients with uncircumcised men have a high (35%) prevalence of balanitis, which gives them cracks to the foreskin. Among men with an acquired tight foreskin, 26% had a history of diabetes. Tight foreskin (phimosis) in men increases the risk of infection of the foreskin and glans.
Balanitis xerotica obliterans (BXO) is a chronic, progressive, and sclerosing inflammatory foreskin disease of unknown cause. BXO will produce scars and cracks.
Treatment of the cracks is medical (antifungal, antibiotics and steroids) and surgical (dorsal slit, preputioplasty or circumcision). Control of sugar in diabetes patients is key in managing the above treatment.
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London Circumcision Centre, London and Luton
