Photo Quiz

A Lesion That Should Raise Suspicion

Am Fam Physician. 2000 Nov 1;62(9):2095-2096.

During a particularly hot and humid period in July, a five-year-old boy presented to the office with a three-day history of erythema, swelling and tenderness of the penis. No dysuria, hematuria, abdominal pain or fever was present. During the previous weeks, the patient had frequently played in a swimming pool.

The physical examination demonstrated maceration of the coronal edge of the glans penis (Figure 1) and adjacent erythema and swelling of the penile shaft (Figure 2).

---

FIGURE 1.

Question

Given the history and physical examination, which one of the following is the cause of this lesion?

• A. Paraphimosis.

• B. Strangulating hair.

• C. Noncandidal balanitis.

• D. Candidal rash.

Discussion

The answer is B: strangulating hair. Paraphimosis occurs when the foreskin is retracted beyond the coronal ridge and cannot be moved forward, which can lead to penile edema. It would not, however, be expected to cause a fissure. The history and physical examination were inconsistent with the diagnosis of noncandidal balanitis, which is associated with allergic contact dermatides, such as those caused by poison ivy and neomycin.

A diagnosis of candidal rash might be contemplated because of the macerated penis and the history of a moist environment. However, this is less common in children and Figure 2 provides a clue to the actual cause, which is something other than a fungus.

The end of a fine hair may be identified in the area of the swelling (see arrow, Figure 2). The hair was wrapped circumferentially along the corona sulcus, slowly strangulating the glans of the penis.

Gently tugging on the hair could not remove it. A small suture scissors was used to “fish” for the deeply embedded hair. The hair was successfully cut, and the swelling and erythema quickly improved over three days. Some cases have required more invasive surgery to find and remove the embedded hair.

The editors of AFP welcome submissions for Photo Quiz. Guidelines for preparing and submitting a Photo Quiz manuscript can be found in the Authors' Guide at http://www.aafp.org/afp/photoquizinfo. To be considered for publication, submissions must meet these guidelines. E-mail submissions to afpphoto@aafp.org.

Copyright © 2000 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.