Penile ulcer..HELP!

  1. I have a pt that has come in with scrotal and penile sores r/t excess moisture. The one on the head of the penis presents with some yellow slough, and to see all of it I have to roll the foreskin back. I have put a zinc oxide cream on it since I obviously can't dress it. Any other ideas?
    Last edit by ngodin on Sep 23, '14
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  2. 8 Comments

  3. by   duskyjewel
    Where is the excess moisture coming from? How can that be mitigated?
  4. by   ngodin
    He is a bedbound pt that was wearing attends at home and came in with these wounds. He does now have a foley catheter and we are no longer closing the attends on him so that he can get more air "down there." My concern is the yellow slough that has developed and no way to apply a Santyl dressing. Considering the majority of this wound is folded up in his foreskin, I don't see the likelihood of him drying up and developing a scab. I didn't know if there was anything else I could do besides the zinc oxide cream and leaving him open to air...
  5. by   duskyjewel
    Would temporarily adding powder to his pericare routine be too abrasive? Just long enough to increase dryness and achieve healing.
  6. by   annie.rn
    Has urology taken a look at it? They might have some ideas for treatment and it might be good for a urologist to have a looksie to make sure it is benign. Although rare, I have taken care of a few pt.s w/ penile cancer. In both cases, the cancer presented as a sore on the penis.

    As far as the care of the wound, I'm at a bit of a loss. Very good cleansing w/ some type of moisture barrier product.
  7. by   ngodin
    Thanks!
  8. by   CWONgal
    Zinc oxide can have a drying effect if it's applied thinly (thick white paste formulation). Is the breakdown r/t urine, fecal incontinence, or perspiration? All? Any chance there is a co-existing yeast infection? We often get calls about "mysterious" lesions on genitalia and I often ask for a dermatology consult if I can't gleam anything definitive from the hx. If it's urine that caused it a petrolatum based skin protectant is usually sufficient.
  9. by   Davidaugustyn
    Come on guys we all know where the moisture is coming from! Being a WCC nurse and a male I think I may have something here. Let think fundamentals. We've all seen these before, probably multiple if working with the very sick.
    Underlying issues with all of them?
    1. Incontinence with poor hygiene
    2. Malnutrition
    3. Intact foreskin (most times)

    Your instinct was right. Stick with something sticky. You are not going to heal this from the outside. I see so many wounds nurses try to santyl and tape a gauze to a penis and every time I do I laugh.

    This will only heal from the inside out, with good hygiene and nutrition.
    Get the calories on board, check an albumin, barrier cream it up.
    Often I'll skip the foley if the wound is at the time.

    I often do a one time dose of fluconazole if I see anything that indicates use. Often you will find this with satellite speckled rash areas.

    Never has a penis I didn't see start to heal before discharging them. Unless they were dying...

    Could also try something like a "triad" barrer cream. Zinc based but has some debridement properties. Sticks very well.
    I've always leaned toward NOT debriding at certain areas...heals...heads....penises.....
  10. by   rn_nxt_dr
    Thanks David!
    Healing from the inside out that is always underserved.
    We need more nutritional assessment and follow through with this and diligence.
    Not only what the eyes can see.

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