HPV - Paranoia

[Jon33]

Hello Doctor,
I hope this message finds you well. I had a previous question here:
http://www.medhelp.org/posts/STDs/Wart-on-near-follicle/show/1827930

The information in the link should explain some of my history. After writing my last message I had a visual examination and the dermatologist did not see any other warts, nor did he see evidence of MCV. As a result of my picking at the lesion I had seen, he could not confirm whether it was one or not.

Now 4 months wart free and nearing that ever unattainable 6 month mark, I've succumbed to the paranoia and picking at the slightest bumps repeatedly. I'm also using Aldara and recently, I picked at three small bumps until they became irritated and bled or became very red and then slathered them with Aldara. One of these was visible to me, the others weren't (due to the angle).

The one that was visible to me I've been aware of because it looks like a wart but I thought it may have been scar tissue, a large wart had been removed there 6 months ago or maybe more. It has never been noticeably irritated by Aldara, and came off easily when picked, but bled a bit.

I know that without a visual examination you are unable to tell me if what I saw/had were actually warts, my questions are:

1) If the irritated areas were in fact Aldara acting on a wart would that be grounds to "reset the clock" and start counting to 6 months from 0?

2)  This third bump where I once had a wart...if it has been there as long as 6 months (or at least the 4 I thought I was wart free) but just picked off, is this grounds for "starting the 6 month clock" again?

3) In light of the fact that the fleshy bump I could see has not reacted to Aldara, does this decrease the likelihood it was a wart at all?

Thanks in advance for your insight. I have a dermatologist's appointment in mid February and I am resolute about using Aldara and not picking until then. I just need some guidance in the long gaps between appointments.

Thanks

[Edward W Hook, MD]

Your question is more a documentation of your anxiety than anything else and further re-inforces my sincere recommendation that you seek help in addressing the obsessive component of your concerns.  Clearly (at least for hundreds of others who have received the same advice), if you had a recurrence the "clock" would start again.

I presume that the dermatologist's assessment will based on his/her visual inspection unless another test such as a biopsy is performed.  EWH

[Jon33]

Hello Doctor,

Thanks for you prompt reply, as always. To clarify "If you had recurrent warts our advice about being confident that you had not had a recurrence at six months would be operative." By this do you mean that if indeed this was a recurrence, I should indeed start the countdown to six months again? Also, is there anything a dermatologist will be able to discern assuming I have no visible symptoms by the time I see him again (6 weeks from now)?

Thanks again.

[Edward W Hook, MD]

I'm sorry to hear of your continuing concerns and worry that the repeated self treatment and picking have the potential to lead to scarring and other chronic changes that will be far more troublesome for you than a few innocuous warts.  This is not at all a good thing for you. With your long term health as my guiding concern, I suggest that you speak with a mental health professional who might be able to help you with what may be a harmful obsession.   Dermatologists not infrequently encounter persons who are hurting themselves through such obsessions and I would encourage you to see if he/she might be willing to make a referral

As for your specific questions:
1) If the irritated areas were in fact Aldara acting on a wart would that be grounds to "reset the clock" and start counting to 6 months from 0?
If you had recurrent warts our advice about being confident that you had not had a recurrence at six months would be operative.  In approaching things this way I would only accept the definitive diagnosis of a dermatologist however.

2)  This third bump where I once had a wart...if it has been there as long as 6 months (or at least the 4 I thought I was wart free) but just picked off, is this grounds for "starting the 6 month clock" again?
See above- no!!

3) In light of the fact that the fleshy bump I could see has not reacted to Aldara, does this decrease the likelihood it was a wart at all?
Yes it does.  You may well have been picking at a scar.

I hope my comments are helpful.  Please take care of yourself- this means stop picking and applying Aldara.  EWH