Brief Answer:
Post inflammatory hypopigmentation or PIH.

Detailed Answer:
Hello,

Welcome and thanks for posting your query to the forum.

I can understand your concern for the spots on the penile skin.

After analyzing your picture with best diligence let me reassure you first that these are simple pigmentary spots known as post inflammatory hypopigmentation or PIH.

To tell you simply about this condition - our skin contains special color producing cells known as melanocytes. These continuously secret color in the skin. In case of any injury or inflammatory process these tend to produce more color. As the penile skin is very thin so it has got more tendency as well as more prominent of these cells.

In your case as we can see that the spots are quite dark which emphasise the previous inflammatory episode 7 years back. This is very commonly seen entity and never cause any future problems.

The only concern is cosmetic appearance of the area. In my patients I suggest them to relax for the same as we can't apply any depigementing agent because of thin nature of the skin.

I reassure you again that this common and simple condition without any future implications.

I hope this helps.

With regards,

Dr Sanjay Kanodia
MD - DERMATOLOGY & Sexually transmitted diseases

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Brief Answer:
Frictional scar and PIH are interrelated.

Detailed Answer:
Hello,

Welcome and thanks for your further follow up.

In my opinion I agree with the doctor giving the diagnosis of frictional scars. The part of frictional scars and post inflammatory hyperpigmentation are interrelated. I quite often see patients with frictional scars eventually turning into post inflammatory hyperpigmentation. Scars can later on form PIH.

I disagree with the part of an eczema over the area. It is because of the fact that penile skin and that too tip and glans along with surrounding skin are not the cooking sites for eczematous condition . Further speaking even if we consider an eczema then is not present in streak like pattern. Streak like pattern is most often seen in frictional conditions. Last but not the least an eczematous condition always has a tendency for increase productivity decrease or subside completely to have total normal appearance.

So I reassure you again that the condition is totally benign and normal one.

I hope this helps.

With regards

Dr Sanjay Kanodia
MD

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Brief Answer:
Various suggestions for PIH marks.

Detailed Answer:
Hello,

Welcome back and thanks for your further follow up.

I guided you before that the condition has got no correlation with any STDs. I reassure you with the best of my experience that none of the Sexually transmitted disease manifest or have sequel in such a manner. You can see that these are linear markings. Such kind of PIH markings are common in simple cuts or frictional ulcers.

Herpes in particular either don't leave such kind of PIH marks or if at all have marks then are in circular grouped manner. So I firmly reassure you for nonexistence of any Sexually transmitted infection including herpes.

For the part of cosmetic appearance or the physical appearance of the area - in my patients I reassure them that it is normal and natural to have such kind of marks. As the skin is a very thin and fragile, so using any mode of therapy could cause further irritation or ulceration and complications.

I reassure you fully for the simple nature of this condition.

My best wishes for your healthy life.

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Brief Answer:
Further information for your condition.

Detailed Answer:
Hello,

Welcome back and thanks for your further swift follow up with queries.

A simple of the thing which you should understand is that any of the inflammatory conditions could lead eventually to post inflammatory hyperpigmentation. We can't deduce the exact cause of present PIH condition just by it's appearance or the present morphology.

So in my opinion I would not like to commit it to any condition including Lichen planus too. I better would like to perform a skin biopsy before designating as the autoimmune condition of lichen planus. There are also multiple points of symptoms related to itching or burning or irritation over the affected area before designating as lichen planus.

Presently it is better to simply designate it as PIH for the academic or clinical purpose.

Anyhow whatever the further feedbacks or diagnosis you have got, there must not be any Sexually transmitted infection in the picture which makes all the things even more simpler for you !!!

I hope this allays all your anxieties regarding the condition.

My good health wishes to you.

With regards,

Dr Sanjay Kanodia
MD-DERMATOLOGY & Sexually transmitted diseases

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Brief Answer:
Simple cyst formation. Do not try to pinch or pop.

Detailed Answer:
Hello,

Welcome back and thanks for your further follow up.

The area of concern at the scrotal area appears to be a cystic change after the application of wart solution. It is occurs due to formation of a wall in the skin. It is quite usual to form such kind structure at any healing site.

After the application of wart solution the superficial burnt part falls off and underlying skin becomes slightly more proliferative to form a cyst like structure.

It becomes normal in most of the cases in few weeks. If still it remains the same or increase then could be removed by radio frequency ablation.

I suggest you to wait and watch for couple of weeks. Further I suggest you to not to touch or pinch or pop the area as can get secondarily infected.

I hope this helps.

With regards,

Dr Sanjay Kanodia
MD - DERMATOLOGY & Sexually transmitted diseases

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Brief Answer:
Warts at genital area is mostly due to sexual transmission.

Detailed Answer:
Hello,

Welcome back and thanks for your swift follow up.

The most common mode of wart infection is through sexual transmission. Less commonly it can occur from non sexual mode meaning by from any other non genital site infected with wart.

I suggest you to check your partner for any small eruption or XXXXXXX warts at the genital area. Avoid sexual intercourse till complete healing. Use condoms for safer sex and wash your genital area thoroughly after every sexual act or better take bath.

My best wishes for your healthy life.

With regards,

Dr Sanjay Kanodia

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Brief Answer:
No any major health concern. It can occur in anyone.

Detailed Answer:
Hello,

Welcome back and thanks for your further follow up.

Warts over genital area are majorly due to sexual transmission. As your femsle psrtner hsve had history of HPV so ask your female partner to report to her gynecologist for the occurrence of warts in yourself. Her gynecologist would examine and follow necessary management for the same.

There is no health issues in the occurrence of warts. These very well can occur in all healthy individuals and is very much treatable and curable condition. So you should not at all be worried about the same.

All the best.

With regards,

Dr Sanjay Kanodia

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