Molluscum Tiebreaker

Hey, Doc.  I recently spotted two red, pimply looking bumps on the lower shaft of my penis.  One dermatologist diagnosed them as Molluscum, while another concluded they are most likely pimples.  Please review the following timeline, as well as their analyses, and let me know what you think:

11/22/10: I notice a small, red, pimply looking bump near the base of my penis, and another similar bump nearby that is even smaller.  The bumps were somewhat shiny, but not glossy.

11/24/10: Dermatologist number one looks at the bumps and concludes that it is Molluscum.  She is surprised to hear they only came two days prior.  She says they look like they are "on their way out" and that they seem to be "old bumps."  I am positive they first appeared two days prior.

As the week progresses, the bumps grow slightly bigger, get slightly crusty, and there appears to be a little dry skin around them.  The area around them looks sort of a whitish look, like dry sweat on a black shirt.  Over the next couple days, the redness starts to dissipate, the bumps get smaller, and, in the center of the bump, you can see a small blackhead/whitehead/piece of dry skin/scab looking spot (Hard to tell).  Today, I wake up and there is a drop of blood in the middle of each bump, apparently due to my scratching the area during the night.

11/30: Dermatologist number two looks at the bumps and says they don't appear to be Molluscum.  He says if they were Molluscum, he would expect them in other areas around the penis shaft, as Molluscum spreads.  He also stated that the bumps appear to be on a hair follicle, and Molluscum is not normally on a follicle.  He tells me they are most likely pimples, gives me something called Duac Topical Gel, tells me to apply twice a day for a week, and says to follow up if they don't go away.

I know it's hard for you to diagnose without seeing the bumps, but based on my description, the timeline, and the doctors' comments, what is your take?

Very much appreciated.

[Jasmina Jankicevic, MD, MSc, CCRP]

Welcome to the Dermatology Expert Forum!

Let me start by pointing out the main differences between two diagnoses.
Molluscum contagiosus (MS) is a viral infection of the skin that present as small raised, round, flesh-colored bumps (papules) with characteristic central indentation. Surrounding redness is possible and indicates that lesions are inflamed. An MS lesion can be accidentally removed by scratching, rubbing or shaving, which can spread the virus.  In adults, Molluscum contagiosum may be a sexually transmitted disease (STD).

Folliculitis is inflammation of hair follicle(s) and symptoms include follicular rash, papules or pustules (pimples), and crusting (possible in later stage). Itching is often present.

Now, you can compare descriptions above with symptoms (objective and subjective) that you have been experiencing.

However, if new lesions appear, few other differential diagnoses should be considered including herpes simplex, candidiasis, penile acne, etc.

Wishing You Optimal Health and Happy Holidays,
Dr Jasmina Jankicevic

[Sr2727]

Thank you for responding, Doctor Jankicevic.  I certainly do not wish to offend in any way, but it seems you haven't taken a position at all regarding the descriptions I've presented (both the subjective, which I suppose are mine, and the objective, which I suppose are the dermatologists').  Rather, you've laid out some facts about the two possible conditions (facts I could have essentially googled myself).  I thought the point of this forum, and the fee I paid, was for you to analyze the facts of my particular case and offer your own hypothesis, with the standard caveat that you cannot be sure of anything over the Internet.  In other words, your response tells ME to compare the conditions to the descriptions I listed - but shouldn't you be doing that? If you are kind enough to do so, I ask that you pay particular attention to the timeline of the bumps' initial appearance and their subsequent changes.  Also, since I posted my question, it seems the cream Dermatologist #2 gave me has been working and the bumps are becoming less and less visible.  Does this fact suggest one diagnosis over the other?  Thank you in advance, and of course I wish you happy holidays as well.

[Jasmina Jankicevic, MD, MSc, CCRP]

Dear Sr 2727,

First of all, we are very glad to hear you are already better.

There was no reason for us to take a position. It is not completely unusual for two dermatologists to give different diagnosis if they see same lesions at different stages of evolution as you kindly pointed out in your post (6 days between visits to two different dermatologists). If you had a chance to focus on specific information we provided about symptoms of two diseases (we did not mention all symptoms but only those which resonated with your concern), you probably noticed that objective and subjective symptoms you enumerated point more towards folliculitis (including type of evolution).

So, your answer was there all the time, we just believe in educating our members while providing answers (empowering approach).

Again, if new lesions appear herpes simplex, candidiasis, and penile acne should be considered too.

Thank you for your comment,
Dr Jasmina Jankicevichttp://www.medhelp.org/posts/Dermatology/Molluscum-Tiebreaker-/show/1405006#

[Sr2727]

Thanks for responding, Doctor Jankicevic.  I appreciate your explanation, as well as your time.  Best wishes.