Chronic dermatitis?

[thisperson]

History:
-22,healthy, active.
-Asthma, allergies. Mother has eczema.
-clean Pap smear every year, tested for all STDs including HIV--all negative. Tested for bacterial and yeast infections, negative.
-symptoms persistant over 4 months. symptoms are not simply 'intermittant', as irritation is varied, but skin has never fully 'healed' and worsens with intense exercise or sweating, etc.

Condition:
Went to Doc for check up and birth control pills and also described to him that I have been having irritation in the vulval area. Some minor itching (though only occasional) but mainly just a feeling of rubbed or raw skin, almost like what an allergy feels like. Sometimes if the area is extremely irritated it would cause a bit of stinging. He did an inspection and found no lumps,ulcers,abrasions,or other areas of concern. Said to use hydrocortisone as needed and keep dry, no soaps, etc.

I have followed his advice, although I ran out of the cortisone cream shortly before moving overseas and have not used it on a consistant basis. When using the cream I noticed improvement, but symptoms were never fully gone or flared back up again.

Last week I went to this doc here (I am in Switzerland) and he did an examination and I tested negative for yeast (under microscope). He did a culture for herpes which will be back soon. This freaked me out. He said he noticed papules on the outer vulva area but he did not think it was herpes but needed to do the culture swab to be sure.

I have never noticed papules of any kind until he really made that area raw with the swab and I saw little tiny ones on one side where he rubbed so hard. The thing is, after a nights rest (no mental stress or moving) they are gone in the morning. They dont hurt and I only notice them upon examination when I have been out all day, hiking or walking around(which rubs and is uncomfortable I might add). But it is eased by the time morning comes.

I am terrified of herpes. Absolutely stressed to the max, which I have noticed makes the irritation worse.

These papules since noticed, do not hurt or itch or have not varied (as in opened up, oozed, anything) And theyre so insignificant to me, because I never even noticed them before, neither did the std doctor who I first consulted about the irritation.  

From the reading I have done, I am leaning towards dermatitis and away from herpes becaused the symptoms have been so constant, without any true change (they may vary from week to week, but the irritation is still there).

Can you assure me at all?  

Here is a list of my sexual lifetime partners. I have been very safe, and this possibility frightens me. 5 in total:
1st-once with virgin, condom protection
2nd-STD tested, no known herpes (1 or 2), unprotected after mutual testing & fully monogamous
3rd-twice with perfect condom use
4th-virgin with unprotected, fully monogamous.
5th-current partner, STD tested, no herpes history, unprotected monogamous relationship.

[Alan Rockoff, MD]

Your symptoms sound nothing like herpes.  Your doctor just wants to be thorough.  I'm sure the test will be negative.  I suggest you leave the area alone and just treat the mild eczema you apparently have with hydrocortisone from time to time.

Best.

Dr. Rockoff

[thisperson]

So it is possible to have a mild eczema, the main symptom not being 'itching'? Is stress and anxiety able to worsen such symptoms (in actuality, not in perception)? And lastly, would severe irritation to an area cause papules which would diminish over a night's rest?

Thanks.

[thisperson]

One more set of questions:
1) If the swab test he took is negative, should I blood test? I mean, is testing a rash or tiny papules enough to show it?
2) Is mild swelling near the Bartholin's gland a possible symptom of irritation/eczema? Because this area has swollen (as of recently, not since the beginning) but goes down by morning. Stress related too? :)

Man, dont you have fun dealing with all the hypochondriacs?

;)

[Alan Rockoff, MD]

Stress can cause such symptoms.

) If the swab test he took is negative, should I blood test?
No.  I mean, is testing a rash or tiny papules enough to show it?  Yes.
2) Is mild swelling near the Bartholin's gland a possible symptom of irritation/eczema? Irritation.  

Dr. Rockoff

[thisperson]

Doc, I hope you check back on this thread...

Got back negative test results, however they decided to do a biopsy. This was all nerve racking, seeing how two people sitting below you talking in a foreign language never feels good. :)

My question is: how close to the affected area does a biopsy have to be to determine the cause of irritation of the skin? Say the most irritated area is a good three inches from where the sample was taken, will it still produce an accurate evaluation?

Also--this is kind of embarrasing, but I have had problems with constipation in the past and a bump like thing (tiny, white head nothing resembling a wart) came from what I believe was a tiny tear on the perineum. I popped it and it quickly shrunk in size, only to return bigger a few days after riding bikes in the mtns. Would a wart do this, shrink and then develop to twice its size? Because now the doc thinks I may have HPV (fun, huh?) But my symptoms of irritation have lasted for months before I definately know that little bump appeared. She said that genital warts would cause the type of irritation I am continually experiencing. I dont get it.

She also did that vinegar test which makes my highly skeptical. I am just at a loss in this big foreign country and would love some advice.

She did the colopscopy (big magnification of the area) and said the perineum lesion appeared to have "ridges" so she wanted to do the biopsy to see. Also on my labia major she said there were hardly visible flat like lesions but there is nothing there, nothing the eye can see and I am scared!

What to think?

If the perineum thing is indeed a wart, does that mean the other is HPV and this is what has been causing all this dermatitis feeling?

I hope you read this, I would value your response so much. Thanks

[Alan Rockoff, MD]

Your symptoms do not sound like herpes.  They do not sound like warts.  Warts do not cause any dermatitis symptoms.  Warts do not grow and shrink rapidly, though irritation from mountain biking does.  The doctor has to judge where to biopsy based on what the skin looks like.

These various diagnoses are all over the place and make little sense to me, though of course I am judging from a distance.  

I repeat: nothing you've said reminds me of herpes or HPV.

Dr. Rockoff

[thisperson]

I agree with you Doctor, and the negative herpes result has taken that worry out of my (and the doctor's) mind.

The biopsy was taken from the perineum area where the bump was. Lets say that the bump is in fact HPV, what about the rest of the area (my whole surrounding vulva)--would a biopsy suggest eczema as well? I just would not want her treating my WHOLE vulval area with some caustic cream if indeed the only problem there is dermatitis. URHHH!

I guess to properly clarify:
a) Will I need a new biopsy if its only the bump thats HPV positive in order to know if the vulva itself is just eczema?
b) Could this bump be a sebaceous cyst or clogged follicle, even if it was painless and never came to head like a regular pimple? The bump was definately not just 'under' the skin.
c) Would constipation had caused this (ie. tear in skin then bump)
d) What about micro papilloma, is that even a logical reason for my symptoms? She said she noted some raised skin under the microscope, but I think thats the friggin eczema or normal varitations
e) Is it normal for this to be out of a gyno's training? Should I just have went straight for a dermatologist?
f) Would other minor growths, bumps, etc. appear to have a jagged top like she said? She said thats what made her think the one was a wart.

***Okay I will stop here. I am sorry if I appear daft, I am just trying to be as best informed as I can be. I could not really relay all these questions to her because of the language barrier!

After this, I'll let it lie--no more threads from me ;)

Your work is a blessing, by the way.

[thisperson]

In addition to question F)
the bump only revealed a jagged appearance under the microcope machine thing during examination. To the eye and touch, there is no appearance whatsoever of the typical 'warty' look.