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Answer to your Health Question

Question (01/30/2011):

Hi, Painful black spots on Scrotum.


Angiokeratoma a is benign cutaneous lesion of capillaries, resulting in small marks of red to blue color and characterized by hyperkeratosis.

"Angiokeratoma corporis diffusum" refers to Fabry's disease, but this is usually considered a distinct condition.

Patients usually give a history of many years of a progressive appearance of asymptomatic papules on the scrotum.

" The patient may not be aware of the lesions, and bleeding (spontaneous, after intercourse or scratching) may be the first presentation causing the patient to seek medical help.

Most authors report that lesions are asymptomatic; however, a few describe pain or itching.

" Fordyce angiokeratomas appear as black, blue, or dark red, dome-shaped papules ranging from 1-6 mm in diameter, with a mean of 3 mm. The overlying surface may show slight scales (hyperkeratosis).

" Reports suggest that in younger patients, the lesions tend to be smaller, more erythematous, and less hyperkeratotic.

Older patients have larger, darker lesions (blue/black) with overlying scales

No fatalities have been reported from this condition. The most significant morbidity comes from bleeding.

The papules can bleed spontaneously if traumatized or during intercourse. Many of the reports describe patient concern that the lesions represent a sexually transmitted disease.

Outpatient treatments such as interventional radiology, lasers, and physical therapy are employed to reduce the severity of the vascular lesions. However, in some cases lasers have caused a reaction in the tissue causing it to expand and become exposed to infection.

Excision and grafting may be necessary to remove the lesion. Recovery time on such an operation ranges from 3 to 12 weeks depending on location of the graft, healing time and the possibility of complications.

Angiokeratomas of Fordyce are benign bumps composed of surface blood vessels. They could be red, or dark blue, or purple. They usually don't hurt unless they are rubbed or scratched and in these situations they may even bleed.

They usually form in people who are around 40 or older.

Apart from Fabry syndrome, which is caused by a genetic defect, the cause of other angiokeratomas is unknown.

Although angiokeratoma of the scrotum is often a benign condition, it has the potential to cause considerable worry and distress to patients.

The initial management of suspected angiokeratoma is to control bleeding with direct pressure.

Once achieved, despite the evidence remaining unclear, it is important to exclude raised intra?abdominal pressure as a cause, especially if there are associated systemic features.

A good history and clinical examination of the abdomen for intra?abdominal masses may help to exclude urinary tract tumours and hernias.

Urinalysis to exclude microscopic haematuria may also help.

The scrotum should be examined for evidence of varicocele, often described as a scrotal swelling mimicking a bag of worms, most evident when the patent is stood upright.

The remaining skin should also be carefully examined for other lesions that may be associated with angiokeratoma corporis diffusum, malignant melanoma and melanocytic naevii.

The lesions generally respond well to local laser treatment but this treatment may cause a reaction in the tissue.


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