Skin Tags vs. GW's

[MakaveliMOB]

Hi Dr - I've got an interesting one for you. I'm a 26/M.  About 2 years ago I saw a lesion on my inner right thigh not in the groin or genitals, thought it was a GW, went to a derm, had it biopsied, it was a "benign keratosis." I became obsessive and started to look very frequently around and noticed other lesions. Biopsied them, they were Skin Tags, Benign Acanthosis. Anyhow, over time, I was reassured that I didnt have HPV by the derm and the STD clinic. So i moved on with my life. Recently, after I  hurt myself down there, I put neosporin in the area. Bad move. Had an allergic reaction, and broke out in a rash. Skin became very dry and the hair follicles became bubble-like. To make a long story short, I looked very closely, and to my surprise I saw a number of lesions in the groin creases, 2 in the left side, 2 in the right side. I was almost sure that they were GW's. I went to the derm, and he said that because they were in the groin, and because of their look, he thought they were Skin Tags. The 2 in the left groin crease are a few mm apart and are quite small. One of the 2 on the right side looks like a flap of skin too, but different looking from the ones on the left. The other one on the right side is the questionable one. It is in the groin crease, It is hard in texture, and it is either sitting on a hair follicle, or a the hair follicle is within, because a hair is coming out of it. However, it is coming out the side of the lesion. The derm thought the hair was independent of the lesion. However, we looked at under close light, i think I see a shadow of the hair within the lesion. As you can tell, I am quite meticulous about these things. As far as my sexual history. I've  been with the same person for about 2 years. Nothing has changed. My mother has a lot of skin tags on her neck. I have some too. But I'm not overweight. I have diabetes in my family. What does this sound like, given this background information? I appreciate your input. Thanks.

[H. Hunter Handsfield, M.D.]

GW usually involve the penis or anus, sometimes the scrotum, rarely the groin.  Given the dermatology opinion you already have, biopsy seems foolhardy.

This comment simply reinforces my advice about professional counseling.  Please consider it.  I'll be willing to take another follow-up comment after you come back to report you have done so.  Until than, there won't be any further responses on this forum, either in this thread or in a new one.  Sorry if this sounds harsh.  Call it tough love.

[MakaveliMOB]

Dr - Thank you for that honest opinion.

I guess my anxiety comes from hearing about some GW being mistaken as Skin Tags, and patients then spreading the GW. I wouldn't want to do that.

My concern is associated with "now" seeing a few more Skin Tags than the first go around. Is that normal?  

In your experience, do you typically see GW in the groin area? My derm said that he typically does not see GW in the groin, unless they have multiplied and spread there from the penis or base of penis.

Any thoughts? I am thinking of getting all of the lesions biopsied, even though the derm does not think it is warranted.

[H. Hunter Handsfield, M.D.]

No distant online expert can second guess a dermatologist's direct examination and diagnosis of a skin lesion.  From both your sexual history description of the lesions, I would not have been very suspicious of genital warts anyway -- and if that's what you had, the dermatologist would have been able to tell.  As to other possibilities -- skin tag, folliculitis, etc -- I have no opinion, since this forum stops at STD issues.

Your self description ("I am quite meticulous about these things") is an understatement.  Based on your many questions on MedHelp over 4+ years, mostly on the Dermatology forum, it is obvious you are obsessed with your genitals and the appearance of your skin in that part of your body -- to an extent that doesn't seem normal.  It suggests counseling might be in order.  I suggest it out of compassion, not criticism.

Regards--  HHH, MD