Male genital eczema

It’s important to keep the genital area clean. However, washing the area too much may encourage further irritation, especially if abrasive sponges or flannels are used. Uncircumcised men should pull back the foreskin in order to wash the head of the penis. 

Wash with warm water and an emollient soap substitute or your usual leave-on emollient. Avoid soaps, antiseptic washes, moist tissue wipes, bubble baths, deodorants, perfumes, fragrances and any other products that could irritate and dry out the skin. Also, avoid using shampoo in the bath since it could inadvertently come into contact with the genital area and cause irritation. If you do need to shampoo your hair in the bath, apply your emollient to the genital skin first and then rinse it off after you have rinsed your hair. 

Good hand hygiene is important when using emollients and topical steroids – always wash your hands before and after applying treatments. If possible, use emollients from a pump dispenser. If you are using cream or ointment from a pot/tub, do not put your hands in and out of the pot as there is a risk of infection – instead, use a clean spoon or spatula to decant the amount you need to use from the pot. 

If you wish to remove hair in the genital area, waxing and shaving products may irritate the skin further. Using your emollient instead of shaving cream may help. 

It is a good idea to check your testicles for lumps once a month after a warm bath or shower. 

Comfortable, loose-fitting clothing will help to lessen irritation and friction. It is best to avoid tight trousers and thongs. Underwear made from 100% cotton, bamboo or silk – or at least containing a high proportion of these materials – should be more comfortable, as natural fibres are less likely to irritate the skin. See Eczema Society’s Clothing and eczema factsheet for underwear stockist suggestions. 

Most people with eczema prefer to use a non-biological laundry detergent to wash their clothes. Finding the most suitable one is a case of trial and error. You may find that you need to wash at 60°C or higher for the non-biological detergent to clean your clothing effectively and to remove the grease from emollients. Always ensure that your clothing is rinsed well. It is best to avoid fabric conditioners because they contain fragrance and other ingredients that bind to the clothing fibres to soften them; these might cause irritation or an allergy. 

When using a topical steroid, leave a gap of 20-30 minutes between applying it and an emollient. This is to avoid diluting the topical steroid or transferring it to areas where it is not needed. It does not matter which is applied first. 

Be careful not to use topical steroids shortly before having sex (including oral sex) on an area that is likely to transfer them onto your partner. They need to be absorbed into the skin first. Topical steroids only need to be applied once a day, so try to apply them at a different time of day to the time you usually have sex. As long as you leave time for them to absorb, topical steroids should not cause any problems. 

Most condoms, diaphragms and caps are made from latex rubber and generally do not cause problems for people with eczema. However, some people have an allergy to latex or other rubber ingredients and they should use products made from material such as polyurethane or silicone. 

Spermicides can also irritate the skin. If this is a problem or concern, discuss it with your pharmacist, doctor, or staff at your family planning clinic. 

Emollients and topical steroids can affect the integrity of condoms and diaphragms, so be aware that the effectiveness of these contraceptive methods will be reduced if creams/ointments have been applied recently. 

Personal lubricants (or lubes) are specialised lubricants that help to reduce friction, pain and discomfort during sexual activity. There are many types available and individuals will have different preferences. Water-based lubricants are water-soluble and are the type most commonly used. They do tend to dry out during use, so you may need to reapply them or add water to reactivate them. Silicone-based lubricants are usually formulated with fewer than four ingredients and do not contain any water. Silicone lubricants feel different to water-based ones and, since they are not absorbed by skin or mucus membranes, last longer. 

Sperm fluid (semen) can make irritant eczema worse; however, a true allergic reaction to sperm or sperm fluid, which in its severest form can cause an anaphylactic reaction, is exceptionally rare. 

Genital eczema can be intensely itchy, leading to scratching. Anti-itch preparations, including anti-itch emollients (Balneum Plus, E45 Itch or Dermacool), may be helpful in relieving severe itching and discomfort, but local anaesthetics should be avoided as they may cause an allergic contact dermatitis. Ask the pharmacist if you are uncertain about a product’s ingredients. You can keep your cream-based emollients in the fridge, as a cold application can be more soothing. 

Some people develop an allergy to nail varnish, so if your partner wears it and you think this may be causing problems for you, see if leaving it off makes a difference. 

If the itching persists, do not try to treat yourself – seek medical advice. You may be offered a blood test if, by reference to your medical history, your healthcare professional thinks it necessary – for example, ferritin (iron) levels might be checked as iron deficiency anaemia can cause itching; or you may need further tests such as patch testing to exclude allergic contact dermatitis. 

Itching may also occur due to yeast infections and STIs, which can cause intense itch and make genital eczema worse. If you have any different symptoms to those associated with eczema, do ask a healthcare professional for further advice. 

If night-time itching is a problem, a sedating antihistamine may help you sleep.