Dermatology/Skin Bumps

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First  
Hello Dr. Fisher and thank you for taking your time to help us who need it.

I noticed a small "zit like" bump in my pubic hair about a week ago and figured it was just that, a zit.  I have since noticed many small red spots scattered throughout my pubic region and one at the base of my penis and the first still hasn't gone away.  I have attached some photos that I took with my phone. The bumps are very small and in some of the pictures I have noticed small white circles within them.  I am a 27 year old male who has been sexually active with women for many years. I do not currently have insurance and my paychecks barely pay for everything I have so I was wondering if you could tell me what you believe them to be and I may have some questions after that. I also have more pictures and will share them if it would help.

      Thank you again, Jared.

Answer
You have a condition called Molluscum Contagiosum..
Molluscum contagiosum is a viral skin infection that causes raised, pearl-like papules or nodules on the skin.

Causes, incidence, and risk factors
Molluscum contagiosum is caused by a virus that is a member of the poxvirus family. You can get the infection in a number of different ways.
This is a common infection in children and occurs when a child comes into direct contact with a lesion. It is frequently seen on the face, neck, armpit, arms, and hands but may occur anywhere on the body except the palms and soles.
The virus can spread through contact with contaminated objects, such as towels, clothing, or toys.
The virus also spreads by sexual contact. Early lesions on the genitalia may be mistaken for herpes or warts but, unlike herpes, these lesions are painless.
Persons with a weakened immune system (due to conditions such as AIDS) may have a rapidly worse case of molluscum contagiosum.

Symptoms
Typically, the lesion of molluscum begins as a small, painless papule that may become raised up to a pearly, flesh-colored nodule. The papule often has a dimple in the center. These papules may occur in lines, where the person has scratched. Scratching or other irritation causes the virus to spread in a line or in groups, called crops.
The papules are about 2 - 5 millimeters wide. There is usually no inflammation and subsequently no redness unless you have been digging or scratching at the lesions.
The skin lesion commonly has a central core or plug of white, cheesy or waxy material.
In adults, the lesions are commonly seen on the genitals, abdomen, and inner thigh.

Signs and tests
Diagnosis is based on the appearance of the lesion and can be confirmed by a skin biopsy. The health care provider should examine the lesion to rule out other disorders and to determine other underlying disorders.

Treatment
In people with normal immune systems, the disorder usually goes away on its own over a period of months to 5 years so the lesions need to be treated.
Persons with a comprimised immune system (such as AIDS) may have a rapidly worse case of molluscum contagiosum.
Individual lesions may be removed surgically, by scraping, de-coring, freezing, or through needle electrosurgery. Surgical removal of individual lesions may result in scarring.

Medications, such as those used to remove warts, may be helpful in removal of lesions, but can cause blistering that leads to temporary skin discoloration. Cantharidin, commonly called "beetle juice," is the most common solution used to treat the lesions. Tretinoin cream or imiquimod cream may also be prescribed.
There is an online medication called MolluscumRX that works about 60-70% of the time.

Expectations (prognosis)
Molluscum contagiosum lesions may persist from a few months to a 5  years. These lesions ultimately disappear without scarring, unless there is excessive scratching, which may leave marks.
The disorder may persist in immunosuppressed people.

Complications
Persistence, spread, or recurrence of lesions
Secondary bacterial skin infections

You are going to have to treat the Molluscum otherwise the lesions are going to spread everywhere.  

Dermatology

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Michael S. Fisher, <B>Ph.D., M.D.</B>

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