second opinion on lichen nitidus diagnosis

[nitidus]

Hello,



I'll try to describe this as succinctly as possible.



Issue:

* Rash on glans penis arranged symmetrically about the urethral meatus

* Consists of reddened skin as well as large number (~ 50) of small (1 mm to significantly less than 1 mm in diameter) individual papules that have remained constant in size for approximately 3.5 months; diffuse papules occur in lower concentration throughout adjacent unreddened areas

* one papule in most reddened area contained a white substance (akin to a whitehead in appearance); may be a clogged pore (if that's possible) as I was applying up to three creams per day during earlier treatments

* Papules do not appear to stain white with acetic acid application (to my eyes at least--they've very small so I don't know how dramatic the color change would be)



History:

* Rash appeared between three and four weeks after a single instance of unprotected intercourse with ex-girlfriend (last unprotected intercourse approximately two years earlier)

* STD results for both myself and her were negative



I've uploaded pictures of the area which hopefully might elucidate things.  



http://paintedover.com/uploads/show.php?loc=0633&f=1_1515.jpg

This is a cropped image of the glans which may be removed as objectionable content by the host



http://fapomatic.com/0649/dscn0649.jpg

This is a full version which should remain up, but is hosted on a site that may have objectionable ads displayed



Currently:

* Referred to dermatologist, who diagnosed lichen nitidus; currently using desonide 0.05% twice daily

* Desonide has almost completely resolved redness (perhaps unsurprisingly)

* Papules remain (after approximately two weeks of desonide application)



My main issue is that my meeting with the dermatologist was under five minutes in length; this had the result that he may have made a diagnosis on erroneous information.  By the way he phrased his reply, it sounded like he thought my girlfriend and I had been involved continuously for a long period.  While we have been involved for a long time, it has not been continuous--I know for a fact that she has been involved with at least one other man prior to this most recent encounter.  He also did not know about the white substance.



So, my questions are:

1) Is there a chance that this is something viral like HPV or molluscum contagiosum? Do you agree with the lichen nitidus diagnosis?

2) If you think it is lichen nitidus, how long do you think I should use the desonide for?  He didn't give me any instructions, but I have three repeats for 25 g each, suggesting that I should be using it for a long period.  Obviously I do not want to wantonly apply steroid cream to sensitive skin (especially if the chances of success are low).  



Thank you for your time.

[Alan Rockoff, MD]

I don't think this is an STD, as much as I can tell by appearance.  I don't know whether these bumps are lichen nitidus--that would require a biopsy, which obviously you wouldn't be excited about doing on the glans penis.  On the other hand, I can't think of anything significant these spots could be.  They may even be unimportant normal variants that you never looked hard enough to notice before.  If you got rid of the redness, I'd stop the desonide (though it's such a mild steroid that you don't have to worry about thinning the skin, etc.)  If you're still worried, I suggest you get another opinion.  But again, it neither sounds nor looks like anything worrisome.  (Vinegar tests are unreliable, by the way, so I wouldn't place any stock in the whiteness.)



Good luck.



Dr. Rockoff

[nitidus]

I realized after the fact that the picture I posted is enormous, so here's a more digestable version:



http://paintedover.com/uploads/show.php?loc=0633&f=1_1515_1.jpg

[Alan Rockoff, MD]

Quite frankly, I don't see any abnormality...



Dr. Rockoff

[nitidus]

Thanks Dr. Rockoff for your prompt reply.  Honestly I didn't originally see much of anything wrong either--it was actually a resident who was examining me for urethral yeast infection (which was present by the way) that first pointed out the redness, which led me to discover the papules.  This set off a four month period of me applying virtually every cream known to man at various doctors' behest. I should also point out that the lighting in those photos is very harsh--the papules are not as shiny and distinct as they may appear.



Anyway, thanks for your opinion.  I think two dermatologists is enough to put this thing to rest.

[Alan Rockoff, MD]

Agreed.



Dr. Rockoff