Common easily diagnosed dermatoses presenting to an STD clinic include:
1. Genital Trauma - abraded or ulcerative areas with a history of overt
trauma or excessive friction.
2. Folliculitis - erythematous pustules with hair follicle in the center; may be
single or multiple.
3. Contact Dermatitis - erythematous papulosquamous eruption, often
pruritic, in areas of known contact to foreign substances (lotions, topical
medications, soaps, etc).
4. Balanitis - often crusting or scaling, erythematous pruritic involvement of
glans, corona, and foreskin of penis. Usually caused by yeast (but <50%
KOH positive); may also be caused by Gardnerella vaginalis, group B
streptococci and anaerobic bacteria, especially in uncircumcised men.
5. Tinea versicolor - hyper or hypopigmented macules on trunk, usually
asymptomatic; KOH+ with “spaghetti and meatballs” pattern.
Less common conditions, which should always be evaluated by the clinic
b. Sebaceous cysts
c. Herpes zoster
d. Fixed drug eruption
e. Hidradenitis suppurativa
f. Pityriasis rosea
B. Treatment: For clear uncomplicated episodes of common disorders, treatment as
1. Genital trauma - good hygiene, avoidance of contact until healed
(especially sexual activity).
2. Folliculitis - good hygiene, hot soaks.
3. Contact dermatitis - good hygiene; over-the-counter 1% hydrocortisone
cream bid x 1 week.
4. Balanitis -
a.) Candidal - OTC antifungal cream (apply bid x 1 week) or
fluconazole 150 mg PO x1. (KOH should always be attempted
b.) nonfungal - if ulcerative, consider empiric treatment for HSV (as
outlined under “genital herpes”), anaerobic balantis (especially if
uncircumcised) with metronidazole 500 mg PO bid.
4. Tinea versicolor - selsun (selenium sulfide) shampoo applied to involved
area daily for 2-3 weeks. Can also be treated with oral antifungal
(ketoconazole or fluconazole) in selected cases after discussion with
For common problems which persist or for less common conditions, the clinic
physician should evaluate and individualize therapy.
C. Follow-up: PRN or per clinic physician.
D. Management of contacts: generally none required; may be individualized by