Dr. Ashwini. V. Swamy
Venereology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I have been experiencing this occurrence of red bumps on my penis head. Initially, it all started with pain with retraction of the foreskin and blisters on the foreskin. To this, I applied candid B cream for three days, this situation was resolved. I stopped applying candid B cream, the next day I could spot red bumps again. After this I consulted a urologist who asked me to run through certain blood tests like HBsAg, HIV, HepC and HSV everything came negative and only I was tested positive for HSV type-1.
The urologist examined the condition and told me nothing to worry and asked me to continue with Candid-B if I ever experience the same. After the consultation, I continued to apply it for about a week and discontinued it. I could not spot any bumps after discontinuing for about four days and then in the morning, I could spot some red bumps. And the main part is these red bumps after applying Candid-B cream, it vanishes and these bumps do not ache or it does not itch nor it oozes blood or pus. Kindly help me in this regard.
Hi,
Welcome to icliniq.com.
I saw your blood report (attachment removed to protect patient identity). It shows that you had a herpes infection in the past, but the IgM is normal meaning no infection at present. Bumps on genitalia are difficult to diagnose without seeing the picture. Can you please attach your clinical picture? Candid B is a combination cream of anti-fungal and steroid. I need to see if it is a fungal infection before I can comment on the cream you are using.
Patient's Query
Hello doctor,
Today I noticed some small white bumps on the top of the foreskin. Pictures are attached with this conversation. Request your opinion on this.
Hello,
Welcome back to icliniq.com.
I saw your pictures (attachment removed to protect patient identity). As per the pictures, those little white bumps look like:
Both look alike, it needs a closer examination with dermoscope to exactly say what it is. Contradicting factor here is the onset of these bumps. You are saying you noticed them this morning. Pearly penile papules and warts both are gradual in onset. Are you sure you noticed it today morning?
Red bumps on tip of genitalia look like a candidal infection. I would suggest you use candid cream (plain Clotrimazole without steroid), not candid B. Apply to the area twice a day after cleaning it with a mild soap like Dove. You need to wash the foreskin every day with warm water and soap.
Patient's Query
Thank you doctor,
Yes, those white bumps on the foreskin were not there, it all started when I discontinued the candid B cream. And when I posted this query, I was worried so applied candid B cream yesterday night and today morning when I see it has vanished (clinical pictures attached). This PPP/warts which you speculate, are they serious? Please advise in this regard. I will change the candid-B cream to candid. Should I be worried?
Hello,
Welcome back to icliniq.com.
Pearly penile papules are harmless, but warts are worrisome as it is contagious. This cannot be a wart or pearly penile papule because they do not vanish off overnight. These are part of candidal (fungal) infection, where there will be pustules, white bumps scattered on glans and shaft called satellite pustules. Since you are seeing temporary relief with Candid B cream, once you stop using Candid B it flares up. Steroid keeps the inflammation under control hence you see improvement. But steroid does not cure the infection, in fact, steroid flares up the fungal infection.
I would not suggest using Candid B for the genital area as it has a steroid in it. It is better if you can switch to Candid cream. It may take three weeks or more to completely clear the bumps. Continue using the Candid cream for at least one month. Also, if you are not allergic to Itraconazole, I suggest taking a capsule Itraconazole 200 mg one-day dosage, one capsule of 200 mg in the morning after breakfast and one capsule of 200 mg at night after dinner. It is only a one-day treatment.
Patient's Query
Thank you doctor,
Those white bumps have opened up and no itching nor pain in the area. I have applied the Candid cream after a bath, so I will bother you if anything that worries me. And about the tablet, what allergy should I take into consideration?
Hello,
Welcome back to icliniq.com.
What I meant was, there can be an allergy to any medication. You need to avoid those tablets to which you are known to be allergic like some people have an allergy to Penicillin. You can take the Itraconazole capsule as I mentioned above. Consult your specialist doctor, discuss with him or her, and start taking the medication with their consent. Practice safe sexual intercourse, and use condoms. Use candid cream. You are welcome to bother me anytime, but I may take a little longer to respond to your query because of the difference in time zone.
Patient's Query
Thank you doctor,
I took a one-day dosage of Candiforce 200 mg. The latest clinical pictures are attached. I do not see any bumps on the foreskin nor the open bumps are fissured, but the red bumps on the penile head are healing and have left behind scars which are evident in the pictures. Maybe they may get better with further use of the cream. For how long I may have to use the Candid cream? Any other medications that I need to take? Any other blood tests that I need to run through? Another thing that is bothering me is that my urine is dark yellow in color after this recurrence. No traces of blood but dark yellow like as we urinate during a high fever. Is this something to worry about?
Hello,
Welcome back to icliniq.com.
Yellow urine is from Itraconazole. Nothing to worry. You need to use Candid (Clotrimazole) cream for at least two to three weeks. You do not need any more medicine as of now. You can get your blood sugar levels checked. High blood sugar predisposes to candidal infection.
Patient's Query
Thank you doctor,
Any comment on the latest clinical pictures sent?
Hello,
Welcome back to icliniq.com.
I saw the pictures (attachment removed to protect patient identity). Lesions appear to be resolving.
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