Wednesday, March 21, 2007

Molluscum contagiosum

Dear Dr. Peg,

I went to see my dermatologist a few days ago about small bumps I noticed on my penis. My dermatologist said they were molluscum contagiosum and she used a liquid nitrogen spray to freeze them off. I had 5 bumps and now they have all increased in size, popped, and are starting to scab up (as my dermatologist explained they would). Something I’ve noticed is that it seems like my penis is smaller now in its flaccid state. Is this common? Will it go back to normal size after the scabs fall off? I started to google side effects of liquid nitrogen and really got myself scared seeing things like necrosis and nerve damage. Have you ever heard of this?
Thanks. A very nervous guy.

Dear Nervous Guy,

Bottom line: liquid nitrogen treatment will not change your penis size. If that’s all you wanted to know, you can heave a sigh of relief and stop reading. If you want to learn a little more about this disease and treatments, keep reading.

Molluscum contagiosum is a skin infection caused by a virus of the same name. Humans are its only host. It is passed by skin to skin contact, or by skin to object (e.g. towel) to skin. Little kids get it from playing together and sharing toys. In adults, if it’s in the genital area, it’s assumed to be sexually transmitted. We see it quite often at the Student Health Center.

Molluscum contagiosum causes small firm bumps with waxy centers. They usually don’t itch or hurt. It can take weeks from the time of contact for the bumps to appear. If you leave them alone, they will go away eventually, but this can take several weeks to months. In the meantime, you are contagious. If you get treated, the duration of the infection is shortened, and your period of contagiousness is also shortened.

Treatment means removing the waxy centers. This is usually done with a tool called a sharp curette, with which we scoop out the center in one swift move. Yes, it hurts a bit, but only for a second. Alternatively, they can be treated with liquid nitrogen, like your dermatologist used. Nitrogen is normally a gas, at room temperature. It’s part of the air we breathe. When it’s cooled and pressurized, it is a very cold liquid. We use liquid nitrogen to treat various different skin conditions, including molluscum, warts, and small skin cancers. By freezing the lesion, we destroy most of it, and your immune system sends cleanup crews to finish up.

There are several other methods of treatment documented for molluscum, including various toxic solutions and lasers. As I said above, the bumps will go away eventually even without treatment, but since it is contagious as long as the bumps are present, I recommend getting them treated.

You asked about complications of liquid nitrogen freezing. This kind of treatment is also called cryosurgery or cryotherapy. As with any kind of intervention, there are possible complications. First of all, pain. It hurts to have tissue frozen, and the area usually stays tender for several days. Bleeding is common, under the skin as a ‘blood blister.’ Infection is possible but uncommon. If the site becomes opened or raw, cover with antibiotic ointment and a bandaid. Long term complications might include scarring, pigment changes, recurrence of the initial lesion, particularly warts, and yes, nerve damage. This last is very rare, I hasten to assure you.

The way your lesions blistered up and fell off is exactly the reaction we’re looking for. Once the underlying sore heals up, everything should be back to normal, including your penis size.

You mentioned that you did an internet search on liquid nitrogen. Let me take this opportunity to comment on internet searching for health problems. Many of our patients do this. Personally, I like it when my patients do some research ahead of time, if it is good research. I especially like it if they have new information for me and can teach me something. I would caution you, however, against sloppy googling. If you’re going to look up health conditions, use reputable sites. Googling by symptom can be especially problematic, because many symptoms can be caused by a wide variety of different illnesses. For example, fatigue can be caused by anything from stress to cancer. Dizziness can simply be from standing up too fast, or it could be from a major heart problem.

One excellent site is This site is created and maintained by the American Academy of Family Physicians, and can be searched by disease or symptom. A web search is never a substitute for a visit to the doctor, but it can provide you with lots of good information.

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