Bumps Follow Up

Hello Doctor,

This is a follow up to a posting from last week regarding bumps around my urethral opening.  I saw a dermatologist last week and he indicated that the bumps were "normal" and that he noticed some irritation - to which he prescribed Alcorton.  I used this for a few days, and the bumps didn't deminish at all (in fact seemed to initially improve - then get worse).  I called back today and he switched me to Lotrisone.  I requested a follow up in 1 week.

My main question is how these bumps could be normal, when they were not there before about three weeks ago?  I subsequently started taking Effexor at the same time, so could that have caused a reaction?  Is there any way that the bumps could be warts and he misdiagnosed them (meaning would a dermatoligist know for sure if the bumps were warts, or could they be mistaken for something else)?  They really arent super obvious unluss you stretch the skin, or if I am erect, in which case it is very upset that something is going on.

I really just want to get this behind me, but I know that these bumps are recent and nothing seems to make them go away.  I know I should just trust the dermatologist, but I can't seem to shake the question of how something could be normal that just flared up like this.

[Alan Rockoff, MD]

There are all sorts of minor skin changes that become visible, hang around for a while, and then go away, all for no special reason.  The penile tip isn't a common area at all for warts, and the dermatologist would certainly recognize warts.  I advise you to trust the dermatologist (or get another opinion from a different one if you must.)  I personally think that the less active medication you use in the area, the better.  Lotrisone has a fairly strong steroid component that I think you can do without.  Check with the doctor on this.

Best.

Dr. Rockoff

[LAConfidential]

Doctor Rockoff,

Thanks for the response.  I did see my dermatoligist again yesterday and he indicated that his intent was to use the Lotrisone only for a day to knock down the reaction, yet somehow his nurse phoned in the script to be used three times a day for 10 days.  After three days, I was very "burned" from the steroid.

He has since had me shift to Vusion Ointment, which seems to be a very delicate "diaper rash" ointment - which he felt would  be good to protect the area and to reduce the rash.  There has been a very noticeable improvment since yesterday, but I still have some small bumps.

He inspected these closely and basically stated that these did not look like any wart he has ever seen, and that the area was an unlikely one - yet didn't 100% rule this out.  My guess is that he is reacting like most experienced physicians who recognize that nothing is ever 100% guaranteed - but I wanted to get your take on whether you would perceive any risk that these bumps could be the "start" of warts/HPV infection?  If it were warts, I assume that they wouldn't get better, then get worse, then get better - but rather would be recognizable as a beginning wart?  I have had warts on my hands, and no that there isn't really any way to mistake them.  His take was normal skin irritation response to the numerous topical applications and that I should see improvement soon.  I just wonder I can stop worrying that I may have contracted warts?

Thanks again!