Question: Hello Dr XXXXXXX I have a question to you regarding a rash around my anus accompanied by white/pinkish growths. I will insert a detailed case log that will give you more information. I also have quite a few photos I would like to send you to help you diagnose my problem. Please read: 2013 April 1st – Started to have an itching sensation around my anus, noticeably worse late at night, during my sleep and in the early morning. Eventually I took Combantrin (Pyrantel Pamoate) thinking that I had pinworms. I did this treatment twice as per the instructions, but nothing changed. XXXXXXX 14th – After continued itching, I decided to take a photo of the area to see if there was any visible signs of a problem. Much to my surprise, there was a large deep red rash around my anus. In the area of this rash, there was a single growth that looked concerning. See photo 1 July 6th – The area was untreated, and the same symptoms remained. I took another photo to see if the rash was getting worse. The rash area remained the same, but the growth that was there on XXXXXXX 14t had disappeared, or at least got smaller. See photo 2 July 9th – I consulted an online dermatologist due to the fact that I was working overseas, and seeing a doctor in person was difficult to schedule. After describing my symptoms to him and showing him detailed photos, he said he believed it was Perianal Psoriasis. I asked him about the growth, and he said he wasn’t sure about it without having a closer look in person, but that it could be a secondary yeast infection. Aug 9th – Went to a walk in clinic to see a doctor about the itch and rash on my bum. The Doctor looked at it, and said he thought it was Candidiasis. He prescribed Fluconazole and an anti-fungal cream called Viaderm K.C. I took the medication on the 9th, and by the 11th, the redness and itch was gone. At the time of the visit, there were two red bumps around the rash. I asked the Doc about them, but he didn’t say much, nor was he concerned about them. Aug 11th – Took the remaining medication as per the Doc’s orders. Sept 5th – While showering and washing myself, I noticed I could feel bumps around my bum. I took some photos, and was shocked to see so many white bumps around the anus. After hours and hours of research, I suspected HPV warts, but was not sure. I heard about using apple cider vinegar (ACV) as a test and solution for warts. Sept 20th – Started using the ACV. After the ACV was applied, all the bumps turned very white, and even places where I could not see any bumps before, there were new white bumps in place. Moderate pain from the treatment, and eventually it started to damage the surrounding skin of the anus. Used it every second night for a week. Sept 30th – After 10 days of using ACV twice a day, I couldn’t notice any difference so I stopped the application. Oct 7th – Returned to my home country from work and immediately went to the Doctor. This was a different Doctor than the first time. He looked at it and determined it was warts. He prescribed me Fluconazole again just to be sure. This time I had to take 150 mg per day for 7 days straight. He also told me there was a good chance I had other STD’s associated with HPV and that I should get tested for AIDS etc. Oct 8th – After more research, I bought some raw unfiltered ACV, tea tree oil and vitamin E cream, oil of Oregano, immune booster and a good multi-vitamin. Started taking the oregano twice a day, and the ACV treatment twice a day. Following the ACV, the skin felt raw, so I apply the tea tree oil and vitamin E cream. See photo 3 Oct 15th – 7 days of Fluconazole didn’t seem to make any difference to the bumps Oct 16th – While I was overseas, I decided to go to a clinic and get blood work done to check everything. I ordered extensive testing and everything came back normal. No STD’s, no AIDS, only high cholesterol and my immune system levels were very high indicating that my body was fighting some kind of illness. See attached lab results Oct 22nd – Went to a urologist. His opinion from his experience was that the bumps were not HPV warts, but he was not sure what they were. He prescribed 150 mg Fluconazole for 3 days and some Nystatin cream. The medication was Spanish, so I didn’t realize it was the same Fluconazole I had already took twice before. Again, it made no difference to the appearance of the bumps. Oct/Nov – The bumps stayed the same, sometimes worse, sometimes better. Off and on usage of ACV, Polysporin and different creams. At one time on Nov 5th, the bumps had almost disappeared, but the rash was quite bad again. See photo 4 Nov 15th – I started to get a dry patch of skin on the shaft of my penis. The online Dermatologist said this was also psoriasis and suggested steroid cream. I started applying the steroid cream twice a day to the affected area, and also started using it on the rash around my anus. Nov 17th – After 2 days of the steroid cream, the rash around my anus improved drastically, and started to clear up the psoriasis on my penis. See photo 5 Nov 22nd – Steroid cream completely cleared up the psoriasis on my penis, but seemed to make the bumps on the anus worse. Stopped application to both areas. Did some more research and decided to try Tea Tree and Castor Oil. See photo 6 Nov 27th – Started applying Tea Tree and Castor Oil twice a day along with Apple Cider Vinegar 2 days on, 1 day off. See photo 7 Dec 2nd – The Tea Tree and Castor Oil seemed to be making an improvement (also ACV). Bumps on the right side of the anus were not noticeable to the touch while showering. Dec 7th – Continued use of TT, CO and ACV – but almost seems like some new bumps are appearing, and the bigger ones are not changing. Dec 18th – The rash came back and was the worst it had ever been. See photo 8 Dec 30th – The growths seemed to be growing and multiplying much quicker. See photo 9 2014 XXXXXXX 6th – The growths around the anus started to get considerably worse, to the point that the entire anus opening was covered. See photo 10 XXXXXXX 12th – By this time, the growths were out of control, and I was very concerned. I was in Ecuador at the time, and decided to see another dermatologist there who specializes in STD’s. He was well known in Ecuador for his experience and diagnosis of STD’s. He looked at the rash and growths and immediately said that it was not HPV. He took a swab of the growth anyway and sent it to his lab for analysis to be sure. The results came back negative for herpes and HPV. He told me the rash was psoriasis, and the growths were a type of Keratosis – an excess of Keratin caused from the psoriasis. He said I needed to treat the rash first, then the growths later. For the rash he prescribed a homemade coal tar cream. It was very nasty to use, had a terrible smell and stained everything it touched – but it seemed to take the rash away. For the growths, he said he could either cauterize them, or I could use some liquid to apply to them that would burn them away. I am assuming this is a type of acid treatment, but in Spanish, I never did understand what it was. See photo 11 XXXXXXX 15th – Started to use the acid treatment on the growths. There was no pain when actually applying the liquid, but a day or two later, there was some discomfort. Every day of using the liquid, the growths started to turn white/yellow, and started to look like they were dying. After 4 days, there was basically just a mass of dead tissue covering the anal area. This dead tissue scraped off quite easily and revealed tender, red unhealed skin underneath. I used Polysporin to try to heal this area and it worked well. Eventually after healing, you could see some growths remaining, and selective spot treatment of these growths got them under control. Eventually by Feb 12th, the area was healed and looking quite good compared to how it did on XXXXXXX 15th. See photos 12, 13, 14, 15, 16 and 17 Feb 25th – The psoriasis/rash returned again, and worse than it had ever been. Also, around the hole of the anus, I could see more finger like growths starting to form. See photo 18 March 3rd – The growths continued to get worse, so I started another acid treatment of the area. I used a Q-tip to apply the acid specifically to the growth itself as to not damage the good skin surrounding it. See photo 19 March 11th – This time, because there were less growths than the first time, the area healed quite quickly, and looked even better than it did after the first treatment. I was quite pleased with the results. Even the rash had almost disappeared. I thought for sure that this time I had cured my problem. See photo 20 March 13th – I started to feel an itch again, and after inspection noticed that the rash had reappeared again. I started using over the counter hydrocortisone cream, and it did help, although never got rid of the rash entirely. See photo 21 March 22nd – I was taking some photos of the area to see if it was getting worse. I could see that in the center of the anal hole, the growths were starting to grow again. This time I started thinking that maybe these growths were coming from the inside, and working their way out where they continued to grow. I decided to use my fingers to spread my anus apart, and take a photo. I was shocked to see the interior walls of my anus completely covered in these translucent finger like growths clumped together in a mass. At this point, I find it hard to believe these growths are due to an over growth of keratin. I do believe the rash is psoriasis, because 2 different dermatologists determined that it was. My question is, what could these strange, never ending growths actually be, and how can I get rid of them forever?

Thank you for your quick response. I wonder why other doctors have so many different opinions. I am a straight male, and have never had anal intercourse. Why do I have these warts on my anus, and nothing on the scrotum or anywhere on my penis? If these are warts, would they not be spreading to other areas? The dermatologist I met before who said this is a build up or keratin gave me an acid type liquid. All I have to do is apply it once or twice, and all the bumps disappear. If I just keep using this acid once per month when needed to keep the bumps under control, will they eventually stop appearing? Thanks

Hello again, thank you for your answers. After talking to you, I showed the same recent photo to the dermatologist I saw before, and now he says the assessment is correct, and it is HPV warts. I also asked him what the liquid was that he gave me, and he said it is podofilotoxina, not TCA. The application is very successful, and only takes a few days to get rid of the warts. I have some additional questions. 1. Can I use this same liquid on the internal area of the anus to treat the ones inside? 2. Is it normal for some of the warts to reappear, and need treatment again so quickly? I seem to have to use it every 4 weeks, but each time there are less and less warts. It seems like if I can keep them under control from the inside out, I don't get them on the skin around the anus as much as before. 3. I was tested for HIV, Herpes, and Syphilis and they were all negative. Is there anything else I should be concerned about due to the fact that my body can't seem to fight these off naturally? Is there anything else I can do to keep these under control. Basically, I would like to know if my condition is normal as far as the time that I have had them, how they repeatedly return etc. Thanks