Author: Dr Mark Duffill, Dermatologist, Hamilton, New Zealand, 2008.
Pearly penile papules are small dome-shaped to thread-like skin-coloured bumps that are typically located on the sulcus or corona of the glans penis. The papules are commonly arranged all the way around the head of the penis in one or several rows.
Penile papules have been reported to be present in between 8% and 43% of men. They are more common in men that have not been circumcised. They become less apparent with increased age.
The papules do not cause any symptoms but patients are often anxious as to their nature.
Penile papules are a normal anatomic variant. They are not due to sexual activity or lack of hygiene. They are not infectious or contagious, unlike genital warts. They are not malignant or pre-malignant.
The lesions are usually diagnosed by their clinical appearance so no specific tests are required. They can usually be readily distinguished from other lesions found on the penis, including viral warts, molluscum contagiosum and ectopic sebaceous glands (Fordyce spots).
Pearly penile papule shows a typical appearance under the dermatoscope.
A skin biopsy or pearly penile papules has characteristic microscopic features. There is a variable number of thin-walled dilated blood vessels in the dermis with a proliferation of fibroblast cells which may be star-shaped or have multiple nuclei. Concentric fibrosis may also be found around skin appendage structures.
Patients should be reassured as to the nature of the lesions. Treatment is not necessary. If treatment is desired, carbon dioxide laser vaporisation or electrosurgery may destroy the lesions but they may be replaced by scarring.
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