There are many conditions that could cause the appearance of bumps in the pubic area. Genital warts are one of those conditions, but there are other causes that might not be so obvious (or concerning) and could be confused with genital warts. This article will take a look at one of those causes and how to differentiate between them and warts.
Often people mistakes between genital warts, ingrown hairs and herpes rashes. Correctly identifying them can help in early treatment and saves lot of time.
Warts
Warts are growths in the skin and mucous membranes. They are caused by the Human Papillomavirus (HPV),[1] of which there are several subtypes responsible for the appearance of warts in different body areas[2]. The two principle categories that have been identified are genital warts and cutaneous warts.
Genital warts (also known as ano-gential warts) are found in the skin and mucous membranes on or around the genitals and the anus.
Cutaneous warts appear in the skin all over the body, having different appearances depending on the area of affliction and the subtype of the virus responsible[3]. Below we will outline the causes of each, and how they might appear if they happened to occur in the genital area.
Causes of Genital Warts
Genital warts are caused by HPV subtypes 6 and 11 [4],[5],[6] and they are considered a sexually-transmitted disease (STD).
However, this is not the only route of transmission, as genital warts can be transmitted by autoinoculation: a process where a person infected in one site reinfects another site on their body, or through handling warts with the hands and transferring the virus to the target.
This theory is supported by the presence of the DNA of HPV in patients’ fingers. [7]
Clinical Presentation of Genital Warts
Infection with the virus may not lead to the immediate appearance of warts. They may remain dormant and warts may appear weeks later, and can even take as long as 2 years to manifest. [8] [9]
Genital warts usually manifest in a specific form called condyloma acuminata, which resembles a cauliflower: it is a soft, fleshy, pink swelling on a stalk, with a rough granular surface. There may be multiple warts in the same patient and – if close together – they may fuse into one large mass.
Another form of genital warts known as the flat wart presents as small, flat, solitary bumps. This occurs in about a third of cases.[10] [11]
Besides the appearance of the wart itself, there may not be any other symptoms. Warts are embarrassing to many people and may cause physical discomfort.
Genital warts may become itchy, inflamed, or exude fluid or a bad odor. Inflammation and scratching of warts may cause them to bleed. Warts near the urethral opening could interfere with urine flow, resulting in difficulties urinating or a disruption of the stream. [12]
Causes of Cutaneous Warts
Cutaneous warts (the main subtype of which is the ‘common wart’) may also appear in the genital area. They are caused by HPV subtype 2, but may also be caused by types 1, 4, 27, and 57. [13]
In order for the virus to penetrate the skin, there has to be some sort of breach through which it can bypass the top layer (the epithelium). Shaving pubic hair may cause small breaks in the epithelium giving the virus access to the skin.
Like genital warts, the appearance of cutaneous warts may be delayed following infection, taking up to 20 months for warts to appear.
Immunocompromised patients (whose immunity has been weakened by HIV or medications) are more susceptible to warts, showing a much larger number of warts and a smaller possibility of spontaneous resolution.
Symptoms of Cutaneous Warts in the Pubic Region
Common warts can be found in the pubic region or on the genitals, and they usually present as small, firm bumps with a rough surface.
They can be single or multiple and may fuse to form large masses. Each wart is about 1 cm across, and they may be tender if they become cracked.
1 to 2% of cases of warts in the pubic area and around the genitals in adults are actually common warts, whereas in children they account for two-thirds of cases[14].
Ingrown Hairs
An ingrown hair or pseudofolliculitis (also known as shaving rash or razor bumps) is an inflammation caused by a foreign-body reaction to hair, where the hair becomes trapped under the skin surface.[15]
This occurs when the cut edge of the hair penetrates the skin and is commonly caused by shaving or disruption in hair growth following plucking or waxing. Areas that are shaved show the greatest rate of occurrence and include the beard area in men, lower legs in women, the armpits, and the pubic area.[16]
Ingrown hairs manifest as a flesh-colored or red swelling around the hair follicle, which may be tender or itchy. They are likely to bleed if they are shaved. [17] [18]
Causes of ingrown hairs
Ingrown hair is typically caused by shaving, especially close shaving since the cut hair is more likely to retract under the skin surface.
People with curly hair are at an increased risk because the curly nature of the hairs makes it more likely for them to reenter the skin after coming out. An ingrown hair can also occur in straight hairs areas where there are skin folds or scars, which may increase the likelihood of the hairs penetrating the skin. [19]
Research has shown that there is actually a genetic predilection to developing pseudofolliculitis, with dark-skinned people showing a higher predisposition due to a nucleotide substitution in the gene responsible for transcribing a specific type of keratin(a protein found in hair).[20] [21]
Ingrown hairs have been reported as a consequence of an adverse reaction to the oral intake of the drug minoxidil,[22] a vasodilator drug used for the treatment of hair loss. [23]
Ingrown Hair vs Genital Warts: The Differences
Now that we’ve explored ingrown hairs and genital warts, we can move on to why they might be confused with each other and – by highlighting the unique characteristics of each – how to tell them apart.
Why they might be confused
A simple common wart or a flat genital wart may resemble a reaction to an ingrown hair, as both are small bumps with an irregular surface that may be itchy. Though usually red and painful, ingrown hairs may be flesh-colored and painless, which means they are very similar to warts.
Furthermore, a wart may become infected or irritated so it becomes reddish and painful and may closely resemble an ingrown hair. [24]
Acuminate genital warts may look like a large number of adjacent ingrown hairs complicated with keloid formation.
Difference in appearance
Ingrown hairs may show some redness with the skin around them also being red, [25] Common warts are skin-colored or white, but they may be greyish yellow or pigmented. Genital warts are usually pink. [26] [27]
The center of the ingrown hair might be yellow, which indicates the presence of pus.[28] The centers of warts may be black due to thrombosis of blood vessels running through them (in which case they may be called “seed warts”). [29]
Genital warts have a characteristic cauliflower appearance, which is unlikely to be mimicked by ingrown hairs.
Difference in symptoms
Warts are generally painless, although genital warts might be tender to the touch. Ingrown hairs are more commonly painful due to the inflammatory reaction taking place around the hair, with the pain possibly radiating outwards to the surrounding skin.
Genital warts (especially the acuminate variety) may give off an offensive odor. Ingrown hairs are not expected to be malodorous unless the inflammation is severe and becomes infected.
Difference in consequences
Ingrown hairs can cause further troubles including a darkening of the skin, scar formation, temporary or permanent hair loss, or the formation of keloids, which are an overgrowth of fibrous tissue in response to injuries, which not only fills the wound but extends beyond it. [30]
Common warts will usually resolve spontaneously without intervention and without symptoms. Sometimes, blackening of the center of the wart may occur. The time taken for resolution varies greatly, from a few months to years. [31]
Genital warts may also resolve spontaneously after a period ranging between a few weeks and years. Unfortunately, they recur in 25% of cases, which take place any time between 2 months to 23 years after resolution. [32]
A Useful Way of Telling Them Apart
Applying a drop of apple cider vinegar to the bumps may help clear up the confusion. Apple cider vinegar makes the surface of warts turn white, so if it turns white it’s a wart, otherwise, it might be an ingrown hair.[33]
Tips for avoiding ingrown hairs in the genital area
Before attempting to treat pseudofolliculitis, let the hair grow for about 30 days first. Then, if you want to shave again, do the following:
- Moisturize the skin before shaving. This reduces the likelihood of causing inflammation. Lotions containing glycolic acid may be helpful.
- Cleanse the skin using a cleansing pad.
- Don’t shave too close. Leave a little bit of bristle and shave less frequently.
- Use a single blade disposable razor or an electric razor or hair clipper that can be adjusted for length.
- Shave with the direction of the hair, not against. Don’t stretch the skin while shaving.
- Sterilize reusable metal shaving equipment with boiling water and soak plastic ones in antiseptic. [34]
Alternatives to shaving may also be explored. These include topical substances such as Eflornithine cream, barium sulfide paste, and calcium thioglycolate. The drawback with these is that they may cause some irritation.
Other options include Intense Pulsed Light (IPL or flashlamp therapy, which is using high-intensity pulses of visible light composed of many different wavelengths [35], [36]) and Nd-Yag or diode lasers. The downside with lasers is that they carry a risk of changing the color of skin.
[thrive_text_block color=”light”] Bottom Line: Having observed the comparison between ingrown hair vs genital warts, it is clear that not all bumps that appear in the genital area are genital warts.
It may be common warts, or ingrown hairs, which are also known as pseudofolliculitis. Knowing the difference between the different lesions can help with making a decision regarding how to proceed in seeking treatment. [/thrive_text_block]
References:
[1] Griffiths CEM, Barker J, Bleiker T, Chalmers R, Creamer D. Rook’s Textbook of Dermatology. Vol 2. 9th ed. West Sussex, UK: Wiley-Blackwell; 2016; 25.
[2] Badaracco G, Venuti A, Di Lonardo A, Scambia G, Mozzetti S, Benedetti Panici P, et al. Concurrent HPV infection in oral and genital mucosa. J Oral Pathol Med 1998;27 (3):130-134.
https://www.ncbi.nlm.nih.gov/pubmed/9563805/
[3] Badaracco G, Venuti A, Di Lonardo A, Scambia G, Mozzetti S, Benedetti Panici P, et al. Concurrent HPV infection in oral and genital mucosa. J Oral Pathol Med 1998;27 (3):130-134.
https://www.ncbi.nlm.nih.gov/pubmed/9563805/
[4] Aubin F, Pretet JL, Jacquard AC, et al. Human papillomavirus genotype distribution in external condylomata: a large French national study (EDiTH IV). Clin Infect Dis 2008;47:610–15. 229
[5] Krzyzek RA, Watts SL, Anderson DL, et al. Anogenital warts contain several distinct species of human papillomavirus. J Virol 1980;36:236–44.
[6] Arima Y, Winer RL, Feng Q, et al. Development of genital warts after incident detection of human papillomavirus infection in young men. J Infect Dis 2010;202:1181–4. 230
[7] Griffiths CEM, Barker J, Bleiker T, Chalmers R, Creamer D. Rook’s Textbook of Dermatology. Vol 2. 9th ed. West Sussex, UK: Wiley-Blackwell; 2016; 25.55.
[8] https://www.healthline.com/health/healthy-sex/how-long-do-genital-warts-last#istreatment-necessary
[9] Griffiths CEM, Barker J, Bleiker T, Chalmers R, Creamer D. Rook’s Textbook of Dermatology. Vol 2. 9th ed. West Sussex, UK: Wiley-Blackwell; 2016; 25.55.
[10] https://www.zavamed.com/uk/early-signs-of-genital-warts.html
[11] Griffiths CEM, Barker J, Bleiker T, Chalmers R, Creamer D. Rook’s Textbook of Dermatology. Vol 2. 9th ed. West Sussex, UK: Wiley-Blackwell; 2016; 25.56.
[12] https://www.zavamed.com/uk/early-signs-of-genital-warts.html
[13] Griffiths CEM, Barker J, Bleiker T, Chalmers R, Creamer D. Rook’s Textbook of Dermatology. Vol 2. 9th ed. West Sussex, UK: Wiley-Blackwell; 2016; 25.46.
[14] Griffiths CEM, Barker J, Bleiker T, Chalmers R, Creamer D. Rook’s Textbook of Dermatology. Vol 2. 9th ed. West Sussex, UK: Wiley-Blackwell; 2016; 25.47-25.50.
[15] https://www.dermnetnz.org/topics/folliculitis-barbae/
[16] Hay, R. J., Morris‐Jones, R., & Jemec, G. B. (2016). Other Acquired Disorders of the Pilosebaceous Unit. Rook’s Textbook of Dermatology, Ninth Edition, 1-14. https://onlinelibrary.wiley.com/doi/abs/10.1002/9781118441213.rtd0094
[17] https://www.zavamed.com/uk/early-signs-of-genital-warts.html
[18] https://www.dermnetnz.org/topics/folliculitis-barbae/
[19] https://www.dermnetnz.org/topics/folliculitis-barbae/
[20] https://www.dermnetnz.org/topics/folliculitis-barbae/
[21] https://www.webmd.com/skin-problems-and-treatments/picture-of-the-hair
[22] Hay, R. J., Morris‐Jones, R., & Jemec, G. B. (2016). Other Acquired Disorders of the Pilosebaceous Unit. Rook’s Textbook of Dermatology, Ninth Edition, 1-14.
[23] https://www.webmd.com/drugs/2/drug-3503/minoxidil-topical/details
[24] https://moleremovalat.com/genital-warts/vs-ingrown-hair.html#Why_Is_Ingrown_Hair_Confused_With_Genital_Warts
[25] https://moleremovalat.com/genital-warts/vs-ingrown-hair.html#Differences_in_Appearance
[26] Griffiths CEM, Barker J, Bleiker T, Chalmers R, Creamer D. Rook’s Textbook of Dermatology. Vol 2. 9th ed. West Sussex, UK: Wiley-Blackwell; 2016; 25.48.
[27] Griffiths CEM, Barker J, Bleiker T, Chalmers R, Creamer D. Rook’s Textbook of Dermatology. Vol 2. 9th ed. West Sussex, UK: Wiley-Blackwell; 2016; 25.56.
[28] https://moleremovalat.com/genital-warts/vs-ingrown-hair.html#Differences_in_Appearance
[29] https://www.webmd.com/skin-problems-and-treatments/plantar-warts-palmer-warts#1
[30] Lovell, C. R. (2016). Acquired Disorders of Dermal Connective Tissue. Rook’s Textbook of Dermatology, Ninth Edition, 1-68.
https://onlinelibrary.wiley.com/doi/abs/10.1002/9781118441213.rtd0097
[31] Griffiths CEM, Barker J, Bleiker T, Chalmers R, Creamer D. Rook’s Textbook of Dermatology. Vol 2. 9th ed. West Sussex, UK: Wiley-Blackwell; 2016; 25.50.
[32] Griffiths CEM, Barker J, Bleiker T, Chalmers R, Creamer D. Rook’s Textbook of Dermatology. Vol 2. 9th ed. West Sussex, UK: Wiley-Blackwell; 2016; 25.58.
[33] https://moleremovalat.com/genital-warts/vs-ingrown-hair.html
[34] https://www.dermnetnz.org/topics/folliculitis-barbae/
[35] https://www.dermnetnz.org/topics/intense-pulsed-light-therapy/
[36] https://www.healthline.com/health/ipl-treatment