Genital Warts - Follow Up

[ajborn00]

Hi Doctors,

I had a question related to my original post:
http://www.medhelp.org/posts/STDs/Genital-Warts/show/1860714

Basically, last July a dermatologist froze three textbook looking warts…and during my first follow-up I showed him two other places and he prescribed Zyclara to treat the them. Well, one of the ones treated with Zyclara seemed to flake off around October 1st, and I stopped using Zyclara on October 23rd. To keep my sanity I decided not to check the area for a while…but about 1 ½ months ago I checked and the one that flaked off near the circumcision scar seemed to be gone when flaccid…but when I stretch the skin tight, like when erect, I can see a very small flesh-colored bump near, or perhaps right at, the original site. It is mostly round, barely raised, flat and perhaps 1.5-2mm across when the skin is stretched. To be honest, it is somewhat hard to see…but in the right light I can definitely see it and I can also feel it when I run my finger across it. Thus, I’m not sure if it never fully went away and is the original…a recurrence…or a totally different bump. Normally, I wouldn’t think anything of it…but it concerns me as it is at the same spot as the original. I’ve scheduled an appt. with my dermatologist, but had a few questions before I go:

1. I understand that it may be hard for him to make a visual diagnosis since it is so small…but if he’s not sure I think I will go ahead and have him freeze it. However, what do you usually recommend to your patients in this type of situation? That is, if you aren’t sure if it is a wart because it is so small, do you recommend freezing, wait-and-see or biopsy?

2. Can warts be so small that you can only see when the skin is stretched?

3. How would a biopsy typically be done on an area like the one I describe? And how long does it usually take to heal…and will it scar? I’m considering a biopsy as my doc is also a Dermatopathologist.

Thanks in advance for your wisdom!

[H. Hunter Handsfield, M.D.]

Thanks for the kind comments.  I'm glad to have helped.

[ajborn00]

Hi Dr. Hansfield,

Thanks for your response. And yes, it was helpful.

I'd also like to say that I'm very appreciative for the work both you and Dr. Hook have done for this site. I have to say...when I was first diagnosed with Genital Warts I was extremely depressed, ashamed, embarrassed and thought my dating life was over. That's when I started doing research and stumbled onto this site. I have read through many of the posts and over time it helped to put my situation into perspective...thanks to the work both of you have done.

Thanks, Dr. Hansfield.

[H. Hunter Handsfield, M.D.]

Welcome back to the forum.

Minor skin abnormalities may persist after treatment of warts -- essentially scar tissue that may appear as a bump or irregularity in the skin.  My guess is that this is what you have -- or perhaps nothing abnormal at all.  But the only way to know is to be professionally examined.

1) Without knowing what you have, or even if anything is abnormal, I cannot and will not recommend any specific treatment.  In any case, I doubt it will be difficult for a dermatologist to make an accurate diagnosis based on visual inspection. You should not suggest what treatment may be necessary.  Just trust the dermatologist to recommend what treatment, if any, is needed.

2) Warts rarely would be so small.  My advice is to stop examining yourself so closely.  Anything you cannot see without "stretching the skin" probably isn't worth knowing or worrying about.

3) I'm not a dermatologist and have never biopsied a wart.  These are questions for your dermatologist.

I hope these comments have helped somewhat.  Regards--  HHH, MD