Skin Tags, Warts, Herpes, etc.

[IraqDale]

Dr. Rockoff,I wrote a few weeks ago (red scrotum then blisters, is it herpes?) and have some follow up questions.Based on what you said about having never heard of "battling molluscum" for 6 years, I researched extensively, and everything I read confirmed what you told me: that molluscum never lasts that long.I went to a dermatologist to have a few of the bumps I thought were molluscum looked at.She agreed that they probably weren't molluscum, given my long history of outbreaks, and did a biopsy.She thought they were much more likely to be warts, which is definitely not what I wanted to hear.She biopsied two bumps and the results came back as skin tags, something I had never heard of until I received the results. I researched skin tags, and they still seemed very confusing to me. Do skin tags behave as my outbreaks behaved: by appearing one or two at a time off and on in the pubic region over a 5.5 yr period? I went back to the dermatologist following the biopsy, and my doctor said that the biopsy did not necessarily rule out the presence of HPV, but merely indicated that those particular legions were not HPV related.At my behest, she biopsied 8 more suspicious areas.I had some more bumps around the base of my shaft, on the upper part of my scrotum, and in my pubic area.The bumps were small, flesh colored, smooth, and perfectly round.There were no hairs in the bumps and they did not appear to be hair follicles or folliculitis.They had distinct edges and were clearly different from the surrounding skin.I will know soon enough (the biopsy results are due back in a few days) but I'm impatient and stressed out.Have you ever seen warts behave this way? By appearing in the pubic region, scattered, perfectly round, and with increasing frequeny over a 5.5 year period? Would skin tags respond to Aldara and Condolyx? These bumps disappeared with the routine application of each topical when used. As for my red scrotum, I know you said it might be herpes (which is not at all what I wanted to hear) but have you ever heard of herpes behaving in the manner in which I described? Outbreak 1: 3 weeks of redness, beginning on the right testicle, ultimately covering the entire scrotum, treated with topical steroidal, sudden outbreak and cessation of blisters, redness is gone. Outbreak 2 (2 months later): 2.5 MONTHS of redness, treated with multiple topical anti-fungals, sudden outbreak and cessation of blisters, redness is gone.  Outbreak 3 (5 months later, current outbreak): 3 weeks of redness, treating with Elidel (doctor said if it's Herpes may help bring it out) and no change.  I understand it sounds like Herpes save for one thing: the extremely long period of extreme redness that precedes it. The entire HSV2 cycles normally lasts 2-21 days.Does it ever last 2.5 months? Does HSV2 persist as long as it has to in order to produce blisters? Is it possible during outbreaks 2 and 3 that my immune system is suppressing the outbreaks for months until blisters appear?

[Alan Rockoff, MD]

Red scrotum is not a typical sign of herpes.  Warts do not look perfectly round.  The way to be sure is to perform tests.  9 biopsies should be quite enough, I think.  Either they will show warts or, just like the first one, a non-wart skin tag.  Biopsies are as close to definitive as a test can get.  I think you should take the results for what they say.  After you get a biopsy report, it isn't generally helpful to continue questioning the behavior of the condition you just tested for, unless you get new areas that look substantially different.

Red scrotum is most often irritation, yest, etc.  To rule out herpes, just for your peace of mind, I advise you get a blood test for herpes 2 antibodies.

I think you really need to put these STD fears behind you.  Once you do the definitive tests--and you're nearly there--it's time to take yes for an answer and move on.

If the bumps turn out to be warts, just treat them and be done with it.  Your doctor can counsel you more completely if (and I mean if) that's necessary.  

Take care.

Dr. Rockoff