Pearly penile papules

Not to be confused with Fordyce spots.
Pearly penile papules
Other names(papules):
(medical condition):
Glans penis with pearly penile papules
SpecialtyDermatology
SymptomsNormal, painless, small bumps on ridge of glans of the human penis[2]
Usual onsetAge 20-30 years[3]
Diagnostic methodVisualisation[3]
Differential diagnosisGenital warts, molluscum contagiosum, sebaceous hyperplasia, lichen nitidus[2]
TreatmentReassurance and generally no treatment necessary[3] cryotherapy, laser therapy,[2] shave excision[3]
PrognosisNot harmful[3]
FrequencyCommon[1]

Pearly penile papules (PPP; also known as hirsutoid papillomas or as papillae coronae glandis,[4] Latin for 'papillae of the corona of the glans') are benign, small bumps or spots on the human penis.[2][3] They vary in size from 0.5-1 mm, are pearly or flesh-colored, smooth and dome-topped or filiform, and appear in one or, several rows around the corona, the ridge of the head of the penis and sometimes on the penile shaft.[2][5] They are painless, non-cancerous and not harmful.[2] The medical condition of having such papules is called hirsutoid papillomatosis or hirsuties papillaris coronae glandis (Latin for 'papillary hirsutism of the corona of the glans').

Cause and mechanism

Pearly penile papules closeup image

PPPs are a type of angiofibroma.[3] Their function is not well-understood.[1] They are usually considered as vestigial remnants of penile spines, sensitive features found in the same location in other primates.[6][7] They do not spread and often spontaneously regress.[8] Along with Fordyce glands PPPs secrete oils to keep the skin of the head of the penis in good condition.[9] Smegma can accumulate if these oils are produced in excess or there is inadequate washing under the foreskin.[9]

Diagnosis

Diagnosis is by visualisation.[3] On dermoscopy, the white-pink papules appear in a cobblestone-like pattern and contain a central dotted or comma-shaped blood vessels. There is no scale.[1] PPPs are sometimes mistaken for genital warts due to a perceived similarity in appearance.[10] They can also appear similar to molluscum contagiosum, sebaceous hyperplasia and lichen nitidus.[2] Histopathology shows dense connective tissue, fibroblasts and many blood vessels.[5]

Treatment

Before and after treatment to remove pearly penile papules

Generally, reassurance is given and no treatment is needed.[3][11] Laser or cryotherapy may be considered for men who find PPPs distressing to look at or feel excessive embarrassment.[1]

Carbon dioxide laser generally has good outcomes with skin healing within seven days.[1] The procedure requires anaesthesia, may need to be performed more than once, and has a risk of bleeding, scarring and colour changes.[1] Another procedure involves a hyfrecator.[12]

Epidemiology

PPPs are common and occur in 14% to 48% of young males.[1][2] Several studies say they are less common in circumcised males,[2] occurring about half as frequently in uncircumcised men, but other studies say the opposite.[13]

Social and cultural

Some men find PPPs distressing to look at, owing to their resemblance to some sexually transmitted infections.[1][14] Although it is not related to any disease, PPPs are occasionally mistaken for HPV warts.[15] There are also home remedies for "curing" it, despite the fact that the papules are neither infectious nor detrimental to one's health and may have beneficial functions.[9][14] Some of the "home remedies" found on the Internet and elsewhere use mild ointments or creams to soften the papules, but others are physically dangerous techniques for papule removal which can result in irreversible damage.[16]

Since dermatologists have safe, effective ways to remove the papules if desired, home remedies involving corrosive substances or self-surgery should be avoided, as they can permanently damage sexual functioning. Removal should only be performed by a physician using proven medical techniques.[16][17]

References

Wikimedia Commons has media related to Hirsuties papillaris genitalis.
  1. ^ a b c d e f g h i Aldahan, Adam S.; Brah, Tara K.; Nouri, Keyvan (May 2018). "Diagnosis and Management of Pearly Penile Papules". American Journal of Men's Health. 12 (3): 624–627. doi:10.1177/1557988316654138. ISSN 1557-9883. PMC 5987947. PMID 27316776.
  2. ^ a b c d e f g h i Love, Lauren W.; Badri, Talel; Ramsey, Michael L. (2021). "Pearly Penile Papule". StatPearls. StatPearls Publishing. PMID 28723057.
  3. ^ a b c d e f g h i James, William D.; Elston, Dirk; Treat, James R.; Rosenbach, Misha A.; Neuhaus, Isaac (2020). "28. Dermal and subcutaneous tumors". Andrews' Diseases of the Skin: Clinical Dermatology (13th ed.). Elsevier. p. 616. ISBN 978-0-323-54753-6.
  4. ^ Harth, Wolfgang; Gieler, Uwe; Kusnir, Daniel; Tausk, Francisco A. (2008). Clinical Management in Psychodermatology. Springer. p. 53. ISBN 9783540347187.
  5. ^ a b Johnstone, Ronald B. (2017). "34. Fibrous tumors and tumor-like proliferations". Weedon's Skin Pathology Essentials (2nd ed.). Elsevier. p. 614. ISBN 978-0-7020-6830-0.
  6. ^ "Pearly Penile Papules: A Common Cause of Concern". International Journal of STD & AIDS. 10 (11). 1999.
  7. ^ Kumar P, Das A, Savant SS (2015). "Multiple Shiny Papules on the Shaft of the Penis". Indian Journal of Dermatology. 60 (3): 325. doi:10.4103/0019-5154.156491. PMC 4458986. PMID 26120199.
  8. ^ Brown, Clarence W (8 July 2020). "Pearly Penile Papules: Background, Pathophysiology, Etiology". Medscape. Archived from the original on 30 June 2021. Retrieved 20 October 2021.
  9. ^ a b c French, Kathy (2009). Sexual Health. Chichester: Wiley-Blackwell. pp. 31–32. ISBN 978-1-4051-6831-1.
  10. ^ Li H (28 August 2015). Radiology of Infectious Diseases. Springer. p. 405. ISBN 9789401798822.
  11. ^ Paller, Amy S.; Mancini, Anthony J. (2020). "9. Cutaneous tumors and tumor syndromes". Clinical Pediatric Dermatology: A Textbook of Skin Disorders of Childhood and Adolescence (6th ed.). St Louis, Missouri: Elsevier. p. 251. ISBN 978-0-323-54988-2.
  12. ^ Marwah, Deepak (2019). Final Edge: Image-based Questions (3rd ed.). New Delhi: Jaypee Brothers Medical Publishers. p. 358. ISBN 978-93-5270-431-6.
  13. ^ Agha K, Alderson S, Samraj S, Cottam A, Merry C, Lee V, Patel R (November 2009). "Pearly penile papules regress in older patients and with circumcision". International Journal of STD & AIDS. 20 (11): 768–70. doi:10.1258/ijsa.2009.009190. PMID 19833692.
  14. ^ a b Pattman R, Snow M, Handy P, Elawad B. Oxford handbook of genitourinary medicine, HIV, and AIDS. Vol. 13.
  15. ^ Pye, Laura (2009), "Human papillomaviruse and vaccination", InnovAiT, Royal College of General Practitioners
  16. ^ a b Rapini RP, Bolognia JL, Jorizzo JL (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN 978-1-4160-2999-1.
  17. ^ Sonnex C, Dockerty WG (November 1999). "Pearly penile papules: a common cause of concern". International Journal of STD & AIDS. 10 (11): 726–7. doi:10.1258/0956462991913402. PMID 10563558. S2CID 25452350.