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Penoscrotal ulcer which resembles Behcet's syndrome, no mouth sores. Syphilis negative. Grown in size.

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Dermatologist
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Hello I am 42, 6'1" and 180 lbs, I've had a penoscrotal ulcer for at least 4 months. Thinking initially it was a regular wart, I've been in denial ever since. Until now it's now over a cm in diameter. I've perhaps aggravated it trying to freeze it off with wart remover. Today I tested negative for syphilis, which the ulcer resembles. It also resembles ulcers caused by Behcet's syndrome, but its symptoms describe profuse mouth sores which I have not had.
Posted Mon, 16 Apr 2012 in Skin Hair and Nails
 
 
Answered by Dr. Rohit Batra 11 hours later
Hello.

Thanks for posting your query.

The ulcer you have could be due to any Sexually transmited disease, Repeated Foliculitis, Sebaceous Cyst, Molluscum Contagiosum etc. It can be because of a wart going on to become a non healing ulcer, though it is very less likely.

It is difficult to jump at a diagnosis only by your history and chronicity of the lesion.

I would suggest you to get a Dermatologist's opinion, as I believe physical examination is must in such cases . You may require a biopsy of the lesion to come to conclusion.

Hope, I have answered your query. I will be happy to answer follow up queries if any.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Penoscrotal ulcer which resembles Behcet's syndrome, no mouth sores. Syphilis negative. Grown in size. 5 hours later
Thank you Dr. Batra, I was examined and given rapid blood tests at a health clinic specializing in STDs and was cleared more or less of the likely suspects (although I still receive urine test results next week). A "sore" specialist examined the ulcer and said he didn't think any STD could create that to his knowledge. He seemed suspicious that I'd created the ulcer by aggressively treating as a wart including many rounds of freezing, etc. He also suggested a dermatologist.

When I selected the options here on this site, I paid more specifically for a dermatologist opinion, but it sounds like your opinion is of a general practitioner.

The ulcer started when i squeezed a tiny itchy pimple like bump and it revealed little pin-size blood dots nearly organized in a pattern. now it is more than a cm in diameter and appears as a shallow flat yellowish fleshtone. It is also nearly perfectly circular with the skin edges around it slightly rolled. The surface itself seems to "sweat" and is mildly itchy. I do not see dark dots at this time, but over the course of treating it, I have seen pore-like holes and believed they indicated the wart virus was still active.
 
 
Answered by Dr. Rohit Batra 12 hours later
Dear,

I am sorry I could not convince you with my explanation during our last conversation. Let me try today.

A viral wart may come up again and again and if Cryotherapy (i.e.) freezing does not give results we move on to radiocautery/ lasers etc.

I would advise you to let the ulcer heal and normal skin grow even if the virus is present. Let it grow substantially to form a papular lesion which can then be removed easily and completely.

It would be helpful to me if you may send me the picture of the lesion. You have a feature to upload the reports / image by yourself at the right side of the query page, please utilize that so that I can answer your queries better.

As far as the healing of ulcer is concerned, you may apply an antibiotic cream. Healing might take some time in case the tissue beneath is damaged to a greater extent by repeated cold injury.

Awaiting your response.

Regards,
Dr.Rohit Batra
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Follow-up: Penoscrotal ulcer which resembles Behcet's syndrome, no mouth sores. Syphilis negative. Grown in size. 13 hours later
Dear Dr Batra

Thank you, I feel helped by your answer, it makes a lot of sense. I've never had a skin ulcer, so couldn't imagine I created it. I do not understand what is an ulcer and what is happening to the skin to cause it to look this way.

I've uploaded 2 pictures which clearly show the ulcer. Any further insight is greatly appreciated.

Thank you!
XXXXXXX
 
 
Answered by Dr. Rohit Batra 9 hours later
Dear XXXXXXX

Thank you for uploading the pictures. I have looked into them in detail.

An ulcer is a loss in continuity of the skin. Like in the picture the upmost layer i.e. skin is missing and one can see the tissue beneath. This is definitely a result of excessive damage caused by Cryotherapy (in your case).

This might take a while to heal as the tissue damage is extensive and XXXXXXX

Though nothing to worry, just keep applying an antibiotic cream to prevent any secondary infection.
I don’t think there will be a regrowth of any wart in this case.

Regards,

Dr. Rohit Batra
Above answer was peer-reviewed by
 
Follow-up: Penoscrotal ulcer which resembles Behcet's syndrome, no mouth sores. Syphilis negative. Grown in size. 23 hours later
Dr Batra

I want to say thank you very much for a thorough and helpful answer to my health concern.

How long (range) is "a while" to heal?

I think there has already been some improvement with only soap and water cleansing and antibiotic ointment applied. I am also taking amoxicilin for good measure. I had no idea skin could behave this way.

Thanks again

-Eric

 
 
Answered by Dr. Rohit Batra 25 hours later
Dear XXXXXXX

Thanks for follow up.

Every person has a different healing power . Also healing depends on the extent of damage caused, more the damage - more the time it will take to heal.

As in your case you are seeing some visible improvement already, so there is no need to be impatient and the ulcer will heal for sure - slowly but surely.

Hope, this helps to relieve your anxiety.

Wish you good health.

Regards.

Dr.Rohit Batra
Above answer was peer-reviewed by
 
Follow-up: Penoscrotal ulcer which resembles Behcet's syndrome, no mouth sores. Syphilis negative. Grown in size. 43 hours later
Dear Doctor Batra

I've posted a new image. I'm wondering if you can judge if there has been any progress in healing There is at least one feature that looks like a pore (perhaps 2 more). Previously I was treating the appearance of these as wart signs, but now I'm leaving them alone. The ulcer is becoming morevpinkish in appearance which I assume means more blood vessels. Why doesn't it scab like normal skin?

Thank you

-Eric
 
 
Answered by Dr. Rohit Batra 25 hours later
Dear XXXXXXX

Thank you for posting the new picture. I have seen it.

Comparing the new picture with that of the older one, there is definitely a progress in the healing process. I also could note a granulation tissue at the base of it and the edges of the ulcer are rounded and pink.

Do not manipulate with your bare hands as it can pass some germs over it, can delay the healing.

Regards.
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