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Red spot won't go away
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by calidebate, May 24, 2009
For background, I previously asked a question at: http://www.medhelp.org/posts/Dermatology/Herpes-hpv-Psoriasis/show/921784

To update you since then: The dermatologist also did not believe that it was a STD and put me on a 2.5% hydrocortisone cream.  After a week, I returned because while I had seen slight improvement in most of the papules, one of them had grown in size and looked "angrier".  I was seen by the PA who also did not believe it was an STD, she said we needed to kick it up a notch and placed me on halobetasol 2x/day for 2 weeks.  This made an immediate improvement in the condition and after two weeks went back in for a follow-up.  At this point, all but the one large/angry papule had gone away and even that one was almost non-existent.  The dermatologist recommended that I continue the halobetasol for another 2 weeks to clear that one away & told me that she believed I'd had lichen planus.  The 2 week period of continued cream use ended on Wednesday (5 weeks total cream use -- 1 @ 2.5% hydrocortisone and 4 weeks of halobetasol) by which time that one spot had was gone.  In the three days since, I have noticed some slight pain/irritation and that one spot has started to come back (by Saturday night it was again relatively pink/red and was growing in size).  I am planning on contacting the dermatologist first thing after the weekend, but would like some advice in the interim.

My two questions are:

(1) do you agree with the lichen planus diagnosis and if not, is there anything that you think this might be?

(2) I really don't want this to continue to spread, so I am tempted to start applying the halobetasol and would like your opinion on this, but my concerns are: (a) I want the dermatologist to see it without her opinion being unduly affected by the application of the medicine and (b) I have heard that long-term topical hydrocotisone cream can cause serious negative reactions.

Thanks for your opinion.
Answer:
242489_tn?1210500813
by Alan Rockoff, MDBlank, May 24, 2009
I can't tell you whether it was lichen planus, but it doesn't matter, because lichen planus is just a rash and you don't need to bother treating it if you can't see it.  Steroid creams can thin the skin if used for a long time, though this thinning is temporary.  Having said that, I would add that I see no need for you to use any steroid creams now.  I think you should so nothing and stop looking at and thinking about your penis.  You were concerned, you checked, you checked again.  Enough.

Dr. Rockoff
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