I've had his small red patch on my foreskin for a few years now. it has never gotten worse nor does it itch or have pain. it feels a little rough.

Rash vs lesion: Both psoriasis and lichen planus can give penile rashes, that may have few symptoms.. Less commonly, candidiasis and seborrheic dermatitis can also give persistent red patches. Most of these would improve with one week of otc mild cortisone cream. If no response, a skin biopsy should be done, as rarely pre-cancerous lesions can also look like this.