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An angiokeratoma is a collection of blood vessels that grows just under the skin in response to increased venous blood pressure. These small (usually up to about 3 mm or 1/8 or an inch wide) growths can occur on the scrotum or shaft of the penis in men, or on the vulva in women, or on the lower abdomen in both sexes. They are much more common in men than in women.

Scientists don't know exactly what causes angiokeratomas. In men, sometimes they form after injury, most commonly a literal "kick in the balls." Sometimes they form in men who have blood clotting disorders that make the blood too sticky. They can occur after hernias, when there are tumors of the urinary tract, and as a complication of a condition known as variococele, a dilation of the cord that delivers sperm to the prostate to be mixed into semen. Sometimes they develop on the tip of the penis in a formation that looks like a strawberry.

In women, angiokeratomas are so rarely treated (which isn't to say they rarely occur) that it is difficult to make connections to predisposing events, although they are more common after pregnancy, hysterectomy, or radiation treatment for cervical or uterine cancer.

Even infants can have angiokeratomas, but they are relatively rare in males under the age of 20. By the time a man is 30, he has about a 6 percent chance of developing angiokeratomas. By the time a man is 60, the prevalence of the condition goes up to about 16 percent. Between 20 and 40 percent of women develop angiokeratomas between the ages of 20 and 40, during their prime years for childbearing.

The reason more men go to the doctor for treatment of angiokeratomas is that on men, they are more visible. Many men wonder whether they have the chancre that signals syphilis. However, angiokeratoma has nothing to do with any sexually transmitted disease. Angiokeratomas may bleed after sexual intercourse in either gender, or after scratching in men. In women, they may start bleeding spontaneously during pregnancy. They almost never hurt, and they are almost never itchy.

There are better and worse ways to treat these unsightly blemishes on the genitals and lower abdomen. A really awful way to treat the condition is to use a pipette to put concentrated acid of any kind on the disfiguration. First of all, it's easy to splash the acid on healthy skin. This hurts. It leaves open skin vulnerable to bacterial infection that can spread. Moreover, the angiokeratoma will come back over and over again if it is not removed to negative margins. A little healthy skin has to be removed around the angiokeratoma, but only about 0.2 mm or less than 1/100 of an inch. You can't possibly remove that fine a margin while using a concentrated acid on yourself.

Equally bad ways of handling the condition are using herbal products like mayapple or bloodroot (Sanguinaria). These products can dissolve tissues underneath the blood vessels forming the angiokeratoma. That's not really something someone wants to do to otherwise-healthy sex organs. Home application of freezing agents, wart removal compounds, or liquid nitrogen are also unsafe. Even if you succeed in removing the lesion, you will be left with discolored skin.

An angiokeratoma is really something you want removed by a professional. Surgery is usually impractical. Freezing the lesions almost always leaves permanently lightened skin. Burning the lesions off removes them permanently but leaves scar. Laser treatment by a dermatologist usually gets rid of the angiokeratoma in one treatment and doesn't leave a scar. Avoid self-treatment. See a professional, and see a professional with experience in using laser for treatment of vascular problems in the skin. Alternatively, don't have the lesions treated at all and have sex with an understanding partner.

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