C09992660 / invoice 10000

05/03/2026 Patient seen for paraphimosis about 3 weeks ago. Has been on 1 mg/kg prednisolone ever since 
Owner reported that recently the penis is not sticking out as much, however he is obsessed with licking it and cannot be stopped once his cone is off
O reported she has seen some redness and pustules around the inguinal area, that she has never noted before
the paraphimosis seems to have improved but at times the penis still appears quite dry and the patient seems to still be bothered by it. 
no other changes noted

PE
BAR, anxious but well behaved
skin in the inguinal area presents a few epidermal collarettes + pustules 
no paraphimosis, penis and prepuce examined wnl 


Discussed this is certainly a unique case. 
Explained that the new skin infection may have been caused by prednisolone + excessive licking OR by underlying allergies that are causing him to be itchy
Given the clinical progression of the initial paraphimosis and current pred course, allergic skin dz is lower on the differential list, but can't be excluded

Explained that sometimes paraphimosis might be caused by inadequate hormonal balance, causing penile dryness and discomfort. However before reachign this conclusion we should exclude urinary dz with a full UA (sedivue, dipstick and USG). Less likely, however in some cases neurological abnormalities may also cause neuropathy and wind up pain leading to this condition

Recommended treating the skin infection and dropping off UA sample before starting antibiotics. At the same time, do a gabapentin trial for neuropathic pain

Recheck in 7 days for vaccine and skin 

In the meatime I am reaching out to Dr. Xavier Schneider at QVS regarding hormonal replacement in these patients 

TGH
Gabapentin already at home
clavaseptin 75 mg PO BID x7d 
prednisolone 2.5 mg PO SID (decreased)