Dr. Dhepe Snehal Madhav
Venereology
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Patient's Query
Hi doctor,
I have some black spots and it looks like warts behind my penis. I have a big spot of 2 mm on the surface. There are few spots of three or four numbers on the skin. It also remains black. One of the black spots bled last week. After a week, I started to have itchiness and a burning sensation now. I have attached a picture of the area. What do I have? What should I do?
Hi,
Welcome to icliniq.com.
Please mention whether you had a fever, any history of herpes or diabetes, and when it appeared. Please mention whether you had excess scratching and rubbing of lesions. Please mention whether you had chronic friction. Kindly answer the questions for details.
Patient's Query
Thank you doctor,
I do not have a fever and any history of herpes. I do not have any intercourse for a year. I do not have diabetes. But I am taking insulin resistance medicine for two years. I am taking Glukofen 1000 mg two times a day. I am not sure about my black spots. I do not have excess scratching or chronic friction. I did not purposely rub the lesions. One of my spots started bleeding on its own two weeks back. I noticed other black spots after looking at it carefully. I would like to know whether these are dangerous or not. What do they look like? I started to have bleeding two weeks back and mild burning and itching sensation started two days back. I did a single change that is I switched from dry weather to hot and humid type of weather. Tonight, I am using Hametan cream and it seems to help me a little. Please advise. Thanks.
Hi,
Welcome back to icliniq.com.
A biopsy of a big black spot has to be done to rule out malignancy or melanoma. You can apply Mupirocin ointment at the site of bleeding for seven days. Unusual elevation in the lesion with sudden bleeding is a risk factor for melanoma. Doing an Acetowhite test helps to confirm HPV (human papillomavirus) infection of other warty lesions. You can do all serological workup. You can do electrodessication or thermal cautery for other warty lesions to burn the tissue. You can apply Cidofovir 1 percent gel at night on the wart for 10 days. Apply Aveeno moisturizer twice daily while having a burning sensation for 20 days. Doing tissue removal with a CO2 (carbon dioxide) laser under local or general anesthesia is a better option. Apply anti-bacterial cream like Mupirocin ointment at night for few days after the procedure. Regards.
Patient's Query
Thank you doctor,
Thank you for your assessment. I am unable to find Cidofovir one percent gel. Is there an alternative drug? There is a drug called Mupiron that includes Mupirocin. Can I apply to the site having bleeding? My biggest discomfort is the mild burning sensation in the area. I will apply Aveeno moisturizer. Because of long holidays during this time, there is a lack of doctors and nurses in hospitals. Therefore, I would like to go and get blood work done after this two weeks period. Is my condition urgent or can I wait for two to three weeks to get your suggestions assessed? Thank you for your guidance. Much appreciated. Best regards.
Hi,
Welcome back to icliniq.com.
The clinical variants of wart are small papular, sessile, flat-topped papules and plaques, cauliflower-like wart, and giant wart. These are flat-topped plaques and papules. Sometimes there is bleeding with a secondary bacterial infection. Doing HPV DNA, serology test, Acetowhite test for HPV is needed for confirmation. There is spontaneous regression occurring in 10 to 15 cases. Apply Fluorouracil 5% cream at the daytime locally on the lesion for seven days. Apply Imiquimod 5% cream three times a week at night for a maximum of 16 weeks. Surgical methods such as cauterization, excision under local anesthesia, and cryocautery or CO2 laser are other options. Avoid unprotected sex. Use barriers. Practice safe sex. You can also apply Mupirocin or Mupiron or T-bact or Fucidin cream or Soframycin cream at the bleeding or irritant site. Calamine or Caladry lotion is another option for Aveeno moisturizer. Imiquimod 5% (Immunomodulator) and Fluorouracil 5% are other alternatives to Cidofovir 1% gel.
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