What could be the reason for dark, painless lesions under the head of the penis?

Question

Hello doctor,

I am concerned with the dark lesions under the head of the penis. It could be that the PPP was affected by PIH. It has been there for at least a year. Has stayed the same size. I have also noticed hyperpigmentation around the surrounding area (no lesions). I took an STD test six months after my last sexual encounter and have not engaged in sexual activities for three years now. I was concerned that it was a wart or something. The lesions have not grown since they appeared. Kindly give your suggestions.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and understand your concern. Possible differentials are pearly penile papules (PPP) which are skin colored, smooth, rounded, 1 to 3 mm papules around the coronal sulcus of the glans penis, hypertrophic sebaceous gland, and sessile genital wart. They are seen more in uncircumcised males. No treatment is necessary. Laser ablation or shave excision are treatment options available. No need to worry. PPP is angiofibroma occurs in 50 percent of males. Cryotherapy or electrofulguration may be done. Have you done any history and physical examinations in the past? Is it a painful or painless lesion? Do you have a history of high-risk exposure? Answer these questions for more details. I hope you find this helpful.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

No, they are not warts. They are pearly penile papules (PPP) or angiofibroma or hypertrophic sebaceous glands. Sessile warts are painless genital acrochordons (skin tags) due to chronic friction or masturbation. No need to worry as such. Do answer the questions to rule out doubts.

1. Is there chronic friction?

2. Do you use lubricants or lotions?

3. Is there any pain during sexual intercourse?

4. Are you sexually active?

5. Are you diabetic?

6. Do you have itchy genitals?

7. Is there a burning sensation during urination?

8. Do you have any symptoms like urethritis or urethral discharge?

9. What do STI (sexually transmitted infection) reports suggest?

10. Have you got STD (sexually transmitted disease) panel tests done?

Hyperpigmentation is not visible in the attached image (attachment removed to protect patient's identity) is it of a major concern? Kindly answer these for assessment.

Thank you.