Side effects are rare, but include-

• Prolonged swelling >72 hours.
• Bruising & blistering in 8% of cases. 
• Ulceration- approximately 7% of cases. May take 8 days to heal.
• Scarring from the laser- approximately 1.5% of cases.

Side effects are more commonly seen in darker skin types as laser light picks up the pigment. Dr Bodapati will discuss treatments, outcomes & possible side effects based upon the size, number of angiokeratomas & your ethnic skin type. 

Angiomas will remain & slowly grow to reach a maximum of 6-8 mm in diameter. Thereafter they remain stable. The caveat is that treating smaller lesions early will lead to better results & fewer treatments. 

Angiokeratomas aren’t STDs. You can’t catch angiokeratomas from someone else nor can you pass it on. Angiokeratomas of Fordyce may resemble genital warts however Dr Sarath can tell the difference. 

Cherry angiomas, genital warts & bowenoid papulosis may resemble scrotal angiokeratomas of Fordyce. Pearly penile papules are smaller & flesh coloured. 

My colleague, Dr Sarath Bodapati can easily tell the difference. Management for these conditions are different, hence the importance of diagnosis.

Cost for scrotal angiokeratoma removal is as follows- 

• 1-40 angiokeratomas $990 dermatologist, Dr Sarath Bodapati.
• Greater than 40 lesions $1090 

Most cases require 2-3 sessions, clearance rates for each session ranges between 20 to 60%. For large & or multiple angiokeratomas, 2-3 sessions are required. Darker skin types will require an additional 1-3 sessions.

We use the following lasers to treat vascular lesions; DermaV, VBeam Prima & Perfecta, Sciton Joule 1064. Our laser incorporates in-built cooling sprays, known as cryogen gas. They markedly reduce discomfort for patients during the treatment; especially good for treating angiokeratomas of Fordyce in sensitive areas. 

Lasers are the best way of treating scrotal angiokeratomas. In third world countries  treatments include – 

• Diathermy, cautery or hyfrecation with pin-point needles
• Liquid nitrogen freezing with a probe
• Excision of angiokeratomas
• Topicals (case report of rapamycin cream)

No. Creams have little effect on angiokeratomas, bar a case report (more on that later). If the scrotal areas are itchy (secondary to angiokeratomas), try this for relief-

• Soap substitutes like aqueous cream as a wash
• Aqueous cream as a moisturizer twice a day
• Hydrocortisone ointment three times a day for one week
• Ice to alleviate the itch

Once angiokeratomas are treated, itching often resolves. For angiokeratomas of Fordyce that bleed, apply firm pressure for five minutes. Alleviation of itch will reduce scratching, & hence bleeding. 

*Case report of topical rapamycin has been published. This topical formulation can be obtained online (compounding pharmacy) or via your GP. The formulation is rapamycin 0.25% compounded in anhydrous base. Apply up to twice daily to affected areas on the scrotum as tolerated. This may marginally reduce the size of lesions after daily application for three months.

Darn dermatology is so confusing with long names. Here is the difference- angiokeratomas of Fordyce as described on this page are blue to purple lumpy lesions on the scrotum. They are due to a collection of blood vessels. 

The dude who found these lumps (Dr Fordyce) also named ectopic oil or sebaceous glands on the lips & shaft of the penis as Fordyce Spots. These are clinically different. They present as flesh coloured flat to slightly raised lesions (not blue or purple). Fordyce spots occur on the penis, keratomas on the scrotum. Clear?