the Differences Between False and True Warts: A Dermatology Perspective

Q: the Differences Between False and True Warts: A Dermatology Perspective

First, it is important to clarify a key concept： the diagnosis of skin diseases primarily relies on visual examination. <br>If a diagnosis cannot be made visually, a physician will perform a biopsy, which involves taking a sample of the affected tissue for special staining and mi

The issue of false cauliflower and true cauliflower..?

Hello, I have been feeling something unusual in my genital area, as if something has grown.
Upon looking in the mirror, I noticed a region on the inner side of my labia minora that is about 2 centimeters wide with many small pink, granular protrusions.
Therefore, on May 10, I visited a dermatologist who diagnosed it as genital warts and performed cryotherapy, prescribing an antibiotic ointment and asking me to return for a follow-up in two weeks.
After researching a lot of related information online, I felt very anxious.
So, on May 14, I went to a gynecologist for further confirmation and examination, but the doctor said that since I had undergone cryotherapy, the area had already been damaged, and she could not see anything.
She did not observe any signs of genital warts and quickly dismissed me, leaving my anxiety and numerous questions unanswered.
Later, on May 21, I visited another gynecologist who said it did not look like genital warts, and my vagina appeared normal, but there was a bit of excess discharge, possibly indicating inflammation, so he prescribed a suppository for me.
Currently, the protrusion has flattened, but upon close inspection, I can still see many small pink granules, and there are no abnormalities in other areas.
Additionally, my boyfriend currently shows no symptoms.
Due to my recent unpleasant experience with consultations, I would like to ask a few questions online, hoping you can take the time to answer them.
Thank you!
1.
I read an article about pseudogenital warts (vestibular papillomatosis), which mentioned many cases misdiagnosed as genital warts.
Is it possible that my condition is more likely to be pseudogenital warts? If it is pseudogenital warts, is it normal for the protrusion to flatten after one cryotherapy treatment?
2.
Since the cryotherapy on May 10, I have only applied the antibiotic ointment and have not used any specific medication for genital warts, and there have been no new unidentified growths on my labia or surrounding areas.
Does this mean the likelihood of it being genital warts is very low? Could it be that I discovered it early and sought treatment promptly, preventing any spread?

NARYA, 30~39 year old female. Ask Date: 2013/06/01

Dr. Wu Yuxin reply Dermatology

First, it is important to clarify a key concept: the diagnosis of skin diseases primarily relies on visual examination.
If a diagnosis cannot be made visually, a physician will perform a biopsy, which involves taking a sample of the affected tissue for special staining and microscopic examination.
Therefore, based solely on your description of symptoms, I cannot provide any diagnosis.
As for whether it is a wart or what you refer to as a vestibular papillomatosis, it must be observed directly for accurate assessment.
However, vestibular papillomatosis is not very common and typically does not require aggressive treatment.
If one were to unfortunately develop warts, it can be quite troublesome due to their difficulty in early detection, long incubation period, and high recurrence rate, making treatment very challenging.
After diagnosis and treatment, it is recommended to continue monitoring for at least six months, and if there is a recurrence, immediate treatment should be sought.
There are now specialized creams for warts, such as 3M's Aldara cream, which can be used in conjunction with cryotherapy to enhance effectiveness.
You may consult your physician and use it under medical guidance.

Reply Date: 2013/06/01

More Info

Understanding the differences between true warts (such as genital warts caused by the human papillomavirus, HPV) and false warts (such as vestibular papillomatosis) is crucial for accurate diagnosis and treatment. Your experience highlights the complexities of dermatological conditions, particularly in sensitive areas like the genital region.

1. True Warts vs. False Warts: True warts, particularly genital warts, are caused by certain strains of HPV. They typically appear as small, flesh-colored or pink growths that can be raised or flat and may have a cauliflower-like appearance. In contrast, false warts, such as vestibular papillomatosis, are normal anatomical variations that can appear as small, pink, or flesh-colored bumps on the vulva. They are not caused by an infection and do not require treatment.

2. Diagnosis and Treatment: The fact that you underwent cryotherapy (freezing treatment) suggests that your dermatologist suspected a viral infection, likely HPV. The subsequent observations from the gynecologists that your condition did not appear to be genital warts could indicate that what you initially saw might not be true warts, especially if the lesions have flattened after treatment.
3. Post-Treatment Observations: It is normal for lesions to change after treatment. The flattening of the bumps you observed could be a sign that the cryotherapy was effective, regardless of whether they were true warts or false warts. The absence of new lesions in the surrounding areas is also a positive sign, suggesting that if it were HPV-related, the treatment may have been timely and effective.

4. Further Evaluation: Given your concerns and the conflicting opinions from different healthcare providers, it may be beneficial to seek a third opinion from a dermatologist who specializes in genital dermatology. They can provide a thorough examination and may suggest a biopsy if there is still uncertainty about the nature of the lesions.

5. Psychological Impact: It’s understandable to feel anxious about your condition, especially with the varying opinions from different doctors. It’s important to communicate your concerns clearly with your healthcare providers. They can offer reassurance and help you understand your condition better.

6. Preventive Measures: Regardless of the diagnosis, practicing safe sex and maintaining good genital hygiene can help prevent the spread of infections. If you have concerns about HPV, consider discussing the HPV vaccine with your healthcare provider, as it can protect against the most common strains associated with genital warts and cervical cancer.

In summary, while your initial diagnosis of genital warts was based on the appearance of the lesions, the subsequent evaluations suggest that they may not be true warts. The flattening of the lesions after cryotherapy is a positive sign. Seeking further evaluation from a specialist can provide clarity and peace of mind. Remember, open communication with your healthcare providers is key to managing your health concerns effectively.

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