Pearly penile
papules (PPPs) are benign angiofibromas that present as a single row or
several rows of discrete, smooth, dome-shaped, 1- to 2-mm sized,
skin-coloured papules distributed circumferentially on the corona and
sulcus of the glans penis.
The penile shaft is rarely involved. Although PPPs are asymptomatic,
patients often seek treatment because of concerns about cosmetic
appearance or concerns about having a sexually transmitted infection,
especially genital warts.
Pearly penile
papules develop most commonly in the second and third decades of life
and less frequently after the age of 40. In men younger than 50 years
of age, the prevalence is about 35%.
A higher incidence of PPPs has been noted in black and uncircumcised
male patients.
Pearly penile
papules are characterized histologically as acral angiofibromas. They
are thought to represent phylogenetic residua from animal ancestry and
are thus considered a normal anatomic variant of the penis.
A specific
function has not been identified. It was previously
suggested that the human papillomavirus might play a role in the
etiology of PPPs; however, such an association has not been confirmed.
The development of malignancy from PPPs has not been reported.
Diagnosis
A
diagnosis of
PPPs is made clinically. The differential diagnosis includes condyloma
acuminata (genital warts), molluscum contagiosum, ectopic sebaceous
glands, and lichen nitidus.
Condyloma acuminata are most important to rule out. Unlike PPPs, they
are less uniform in shape and size, tend to be more verrucous, and
might change in appearance over time. In addition, they are not
typically arranged in neat circular rows surrounding the penis, as are
PPPs.
Lesions of molluscum contagiosum tend to be umbilicated and larger in
size, sometimes with a pink hue.
Ectopic sebaceous glands and lichen nitidus are both commonly located
on the penile shaft. Ectopic sebaceous glands are more yellow in colour
and can often discharge a cheesy material.
Lesions of lichen nitidus tend to be flat-topped and are often
polygonal in shape.
In cases in which the diagnosis is uncertain, a biopsy can be
performed, as PPPs and each of the conditions considered in the
differential diagnosis have characteristic histologic findings.
Treatment
As PPPs are
benign, no treatment is required. Patients should be reassured that
PPPs are not due to a sexually transmitted infection and do not carry
any risk of becoming malignant. For those patients with ongoing
cosmetic concerns resulting in psychological distress, treatment can be
implemented. Cryotherapy with liquid nitrogen and carbon dioxide laser
ablation therapy are the 2 most effective treatment modalities. Two
treatments with liquid nitrogen can successfully remove 80% to 90% of
lesions without scarring or postinflammatory pigment changes if
performed by an experienced physician.
Excellent cosmetic results have also been obtained with carbon dioxide
laser ablation therapy,
with the continuous wave laser being more effective than the pulsed
laser.
Pearly penile papules can also be treated successfully with
electrodesiccation and simple surgical excision.
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