Foreskin Rash

[johnnieboy]

Hi,

First some history....

About 4 years ago, I caught genital warts from a girl. They were fairly minor and treated successfully with Warticon (Podophyllotoxin).  At the same time, I decided to have a check-up for herpes as I had noticed a small thin sore which did not seem to be healing properly and would become sore after sex (more like a small crack about 1 cm long just along a fold at the base of the head of my penis under my foreskin).

As a result of a Herpes swab test, the result came back 'weak positive'.  The doctor couldn't explain what this 'weak' result meant, but pescribed me anitbiotics anyway.  

Whilst the sore seemed to heal at the time, I'm not convinced it was due to the antibiotics as opposed to my astention from sex! I still found that whenever my foreskin was stretched the thin skin around the original area would split again along the original crack. This has continued ever since.  

In addition I now have a couple of other similar areas - one along my frenum as well as a larger patch of lighter, almost puffy skin (about 1.5cm sq) that is also prone to splitting if stretched or sore if rubbed (i.e. during sex)

I sometimes find that I do get a small amount of tingling or soreness for no reason too, but this is rare.

Since my original problem I have seen 4 different doctors but none of them have been able to give me a solid diagnosis.  They have all felt that my symptoms do not seem to be herpes or warts and are more likely to be some form of dermatitis.  I have also had two further swab tests for Herpes which have all been negative, as well as other tests for HIV, and other common stds.

I have tried various creams including,
- Hydrocortisone
- Canesten
- Trimovate (some form of steroid I believe)

None of them seem to have been particularly effective. My skin, is still thin and easily aggrevated making sex painful.

My theory is that the doctors are probably right and that the problem is dermatological (although I find this strange as I have never had any other skin problems).  Perhaps the condition was triggered by the Warticon cream I used for the warts (particularly as the patch of puffy pale skin is around the area of this application)?  I suspect that the original diagnosis for Herpes was wrong or I was probably one of those people who may have had Herpes for years, but never known it - hence the reason for the weak positive, and no obvious symptoms.

I have three main questions:

a) Do you have any ideas as to what my specific condition could be (e.g. Lichen Sclerosus perhaps?)
b) Are there dangers of me spreading my condition? Either to myself or others?
c) Do you have any suggestions for treatments?  I'm keen to make the skin more robust and less prone to splitting.  I've been debating whether I could use more aggressive treatments like exfoliating creams or alcohol to encourage the formation of new healthy skin?

I look forward to your help.

Many Thanks,
J.

[Mikeaay]

A related discussion, sebaceous cyst penis was started.

[r2d2]

Hi,
You may have a condition called "Frenulum Breve", which is due to a short lower part of the foreskin which becomes "overstretched" and therefore over brittle during sex.

It does not require circumcision , but something called a "frenuloplasty".

Have a look at this article.

http://www.circumstitions.com/Frenbrev.html

Hal

[andio]

I have been treating genital warts for over 2 months with warticon.... they cleared partly, but i still cannot get them under control,  ANY HELP????

[Alan Rockoff, MD]

Bowenoid papulosis is an HPV-related condition.  If there is contagion, it's the HPV, but that's hard to assess.  Getting them frozen off till they're gone seems the best approach.

Dr. Rockoff

[johnnieboy]

Doc,

Thanks for your response.  I have subsequently been to see a dermatologist, and undergone a full biopsy (ouch!).  The results have just come back, and it turns out I have been diagnosed with Bowenoid Papulosis.  

As a rare disorder this is proving difficult to understand - they say is is caused by HPV, and is contagious.  I'd be interested to hear your thoughts on how contagious this might be?  Is it the skin disorder (i.e. the lesions) that is infectious or the underlying HPV virus?  Can BP exist without HPV? My Doc has used nitrogen to freeze the area - will that cure me?

Thanks,

J.

[Alan Rockoff, MD]

I agree with your assessment--that this is not herpes and that the "weak positive" test (whatever that means) was misleading.

To address your questions:
a. probably friction response
b.  none whatsoever
c. I would lubricate generously before and after sex or other friction.  If the skin splits anyway, abstain for a few days (your comments on the role of abstention are perceptive and no doubt correct.)  If you remain troubled, you may want to consider circumcision.

Best.

Dr. Rockoff