Redspots Under Foreskin

[concerned000]

Hello Doctor.  About 5 weeks ago I had red spots appear under my foreskin and below the glans.  And about a week or two after these spots appeared a secondary condition presented that looks like it could be sebaceous glands.  So I will try to describe these conditions for you the best I can.

There are about 6 red spots under the foreskin.  Like I said they have now been there about 5 weeks and have not changed.  They have not blistered or ulcerated, are painless, do not itch, and I have not experienced any discomfort during urination.  I tried antifungal cream for about 2 weeks but the condition did not respond.  So, I have basically just been keeping the area clean by washing with mild soap a couple of times a day.

As for the secondary condition that I think might be sebaceous glands, the "bumps" go along the sides of my shaft and on the underside of the shaft.  In addition, the hair follicles are also prominent at the base of the shaft and on my testicles and the scrotum appears slightly red but is not irritated.  Sometimes the bumps seems to have a white core or something making its way out.  This substance is pretty small and I can sometimes get it with tweezers--but this is not to suggest that I am picking at the bumps.

For the red spots, I am obviously concerned about herpes, warts, or wonder if it is some type of fordyce spot or balanitis.  The bumps on the shaft concern me for possibly being molluscum contagiosum.

Your help is appreciated.  I have photos also, but I do not see an option for uploading.  Thank you.

[H. Hunter Handsfield, M.D.]

I'm glad you got a proper diagnosis.

I have little personal experience with imiquimod (Aldara); in my STD clinic, we generally used other treatments for warts.  And I have no experience at all in treating BP.  (With your research, most likely you now know more about it than I do.)  But in general, imiquimod is well tolerated; the inflammation usually isn't severe.  But your dermatologist can give you more guidance than I can.

Good luck---  HHH, MD

[concerned000]

Hi Doctor.  I wanted to update you on my condition, as it has finally been diagnosed after biopsy of one of the lesions.

The lesions turned out to be bowenoid papulosis with presence of HPV-16.  My dermatologist has prescribed Aldara for topical treatment.  I will not bother you with questions about this condition because I've read a lot of literature about BP and HPV-16, including your own posts on the subject.  I understand the condition, the risks, and the overall prognosis.

My main questions for you are about Aldara.  I've read that some of the side effects can be quite bad, causing serious irritation to the point of ulceration in some cases.  What should I expect?  Also, the biopsy of one of the lesions was only taken less than a week ago and I'm still healing--the stitch has not even fallen away.  So do you think I should wait until the biopsied area has fully healed?

Finally, thanks for your advice on this (now dating back several weeks).  I'm just glad to finally know what this condition is.

[H. Hunter Handsfield, M.D.]

Herpes is not a possible explanation.  Don't worry about it.

[concerned000]

Thanks Doctor for the advice.  The red spots are slightly raised, but like I said they never formed blisters or ulcerated.  They have remained unchanged for the past five weeks.  Even if these bumps were a "mild" or non-classic outbreak of herpes, would the lesions last this long?

Thanks, and I will look into posing a question to Dr. Rockoff as well to get insight into non-STDs.

[H. Hunter Handsfield, M.D.]

Based on your description, the red spots do not suggest any STD.  On this forum we do not examine posted photos.  For practical purposes, the only STDs that conceivably could cause such a symptom are herpes and the secondary stage of syphilis.  But herpes lesions would turn into painful open sores and then heal, always within 2-3 weeks.  And syphilis rarely causes small spots only in that location; you would have had a body-wide rash.  There are several potential non-STD causes, such as yeast infection or nonspecific balanitis, but this forum doesn't get into non-STD diagnoses.  Or, since the spots are so subtle, they might not be abnormal at all, just natural variation in the color of the skin.

As for the "bumps", your own judgement that they are sebaceous glands might be correct, but I have no way of knowing.  Of course genital warts are the main STD condition that shows up with bumps in the skin.

Bottom line:  I doubt any STD is present.  But the way to know is to see a health care provider.  Or you might consider posing the same question on MedHelps dermatology forum.  Dr. Rockoff sometimes is willing to look at posted photos.  (To my knowledge there is no photo posting capability on MedHelp.  You would have to upload to a site of your choosing and provide the URL in you question.)

Best wishes--  HHH, MD

[concerned000]

Also, I should say that about 4 of the red spots are on the right side under the foreskin, and the other 2 are on the left.  And two of them--one on right and one on left--are further down from the glans.  These two bumps are sometimes barely noticeable.