Introduction
Littre and Morgagni first described pearly penile papules in 1700. Pearly penile papules are common and appear similar to sexually transmitted infections such as condyloma acuminata. They have uniform dome-shaped papules that appear in one or two rows around the penis. It is common in younger adults and adolescents. Most of the time, pearly penile papules are mistaken for genital warts and can cause distress to individuals.
How Do the Pearly Penile Papules Appear?
They have the following presentation:
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They are not itchy or painful.
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Appear as pink, white or yellow, dome-shaped or filiform papules.
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One to two millimeters in diameter and one to four millimeters in height.
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Appear in one or two rows around the corona of the penis.
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Lesions can appear on the shaft of the penis and the dorsal side of the corona.
They are less common in prepubertal children and older individuals, often seen in younger adults and adolescents. In circumcised males, the incidence is less because of chronic abrasion to the exposed area.
What Is the Differential Diagnosis of Pearly Penile Papules?
Tysons Gland: These are the modified sebaceous glands located around the head of the penis and the inner surface of the prepuce of the penis. They have a parafrenular distribution that is absent in pearly penile papules.
Molluscum Contagiosum: It is a viral infection with a presentation similar to pearly penile papules. They present as umbilical papules, larger than the pearly penile papules. Molluscum contagiosum is caused by a pox virus and can present itself in any body part.
Condyloma Acuminata: Also called genital warts, it is a sexually transmitted disease.
Causes of Pearly Penile Papules:
There is no specific reason for the cause of pearly penile papules. It is a normal skin variation with no underlying causes. The skin variation may be due to the overgrowth of collagen, dilated blood vessels, fibroblast, and connective tissue cells. Pearly penile granules are not contagious and cannot be sexually transmitted.
Acral angiofibromas have similar histopathology to pearly penile papules, the features include epidermal melanocytes on a layer of the granular zone along with the absence of basal layer pigment, focally elongated rete ridges in the upper dermis with increased vasculature, infiltration of lymphocytes and histiocytes in the dermis layer and whorled collagen pattern is seen in spindle-shaped stellate fibroblasts.
Who Is at Risk of Developing Pearly Penile Papules?
Uncircumscribed men are at a higher risk of developing pearly penile papules. It is advised not to pick on the papules as they may break open and cause infection. The healthcare provider refers the individual to a dermatologist for further evaluation and treatment.
Do Pearly Penile Papules Have Any Effect on Sex?
Pearly penile papules are not contagious and do not cause any systemic complications, and are a variant of normal skin texture. Still, it does affect the mental health of the individual and complicates the relationship with the partner, leading to distress. Most men with pearly penile papules are worried if they have a sexually transmitted disease and want it immediately treated or removed. This affects them mentally, leading to anxiety and fear of acquiring a sexually transmitted infection. This affects the relationship with the partner, raising concerns about infidelity. Sexual performance may be hampered because of stress and anxiety.
How Do You Differentiate Pearly Penile Papules From Genital Warts?
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The human papillomavirus is the causative agent for genital warts. It is a sexually transmitted infection. On the other hand, pearly penile papules are a natural skin variation and do not associate with sexually transmitted infections.
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Pearly penile papules are dome-like, symmetrical, and smooth, whereas genital warts have a bumpy and cauliflower-like appearance.
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Pearly penile papules are found only on the head of the penis, whereas genital warts are found on the mouth, tongue, lips, scrotum, thighs, groin, and penis.
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Genital warts are a sexually transmitted condition, whereas pearly penile papules are not contagious and do not cause any physical harm to the body.
Do Pearly Penile Papules Go Away on Their Own?
Pearly penile papules are a normal skin texture finding, and having pearly penile papules is not a disease. However, the pearly penile does not go away on its own but may diminish with progressing age. It does not cause any harm and can be left untreated. The individual can get it removed through lasers and cryotherapy if it affects their mental health or their relationship with the partner.
How Is Pearly Penile Papule Treated?
Cryotherapy and lasers are the common treatment modalities used.
Cryotherapy: Cryotherapy has an 80 % to 90 % of success rate. Cryotherapy uses liquid nitrogen to burn the papules. It is a painful procedure, and there is no loss of pigmentation in the affected area after treatment.
Carbon Dioxide Laser: The heat produced from the laser causes evaporation of tissues from the affected area. The laser-induced injury heals rapidly because of the high vascularity of the penile tissue. However, there are chances of bleeding while performing this procedure. The continuous mode has more advantages over the short pulse mode as it provides better hemostasis and operative field visualization. Carbon dioxide lasers have successfully resolved lesions in both light and dark-skinned individuals. After the procedure, it may take up to five to seven days for reepithelialization to occur. The disadvantages of this treatment include increased risk of scarring, infection, postinflammatory pigmentation in dark-skinned individuals, and inconvenience of home dressing.
Ablative 2940-NM ER: Yag Laser: This laser showed a high success rate of clearing all the lesions and no recurrence for one year. The ablated regions heal within two weeks after the procedure. This procedure is performed after failure of cryotherapy, podophyllin, topical Fluorouracil, and Salicylic acid. There is no postoperative scarring or pigmentation observed.
1550-NM Erbium Laser: A procedure performed by this laser is painless and does not create any open wound. Provides complete clearance and no recurrence of the lesions.
Pulsed Dye Laser: It is a nonablative approach that provides complete clearance and no recurrence of the lesion. It is painless and does not cause postoperative complications like infection and scarring. Pulsed dye laser produces extraordinary cosmetic results with no adverse effects and recurrence.
Conclusion
Having pearly penile papules is not a disease. Instead, they are benign lesions that appear on the glans of the penis. They are a normal skin texture finding. They have uniform dome-shaped papules that appear in one or two rows around the penis. These papules are common in younger adults and adolescents. Treatment modalities involve lasers and cryotherapy.
