Pearly penile papules PPP are common, benign lesions that appear on the corona of the glans penis during adolescence or early adulthood. Despite their benign nature, PPP are known to cause significant distress because of their resemblance to sexually transmitted infections such as condyloma acuminata. PPP can be clinically distinguished based on their uniform, dome-shaped papules that orient in one to two rows around the glans penis. There is no association between PPP and sexually transmitted infections, and treatment is generally reserved for patients with excessive concern.
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Pearly penile papules, also known as papillomatosis corona penis, corona capillitii, hirsuties coronae glandis, papillae coronis glandis, and hirsutoid papillomas, are benign lesions of the penis. Pearly penile papules are considered normal anatomical variant. They are rarely observed in children and mainly seen in late adolescence and early adulthood. Their prevalence declines in older patients as the lesions involute with aging. Similar papules have never been described on female genitalia.
Many studies show that pearly penile papules are less common in circumcised males and is they are supposed to be secondary to chronic trauma undergone by uncovered corona which leads to the papule involution.
However, Rehbein, in his study of males, showed a higher prevalence among circumcised people. A recent study in young circumcised men showed a prevalence of Although many studies have shown no race predilection to develop pearly penile papules, Rehbein reported them to be more prevalent in African American males. The exact role of pearly penile papules is not clear to date.
Although pearly penile papules are usually asymptomatic, they are often mistaken by males who carry them for genital warts, thus causing concerns of having a sexually transmitted infection.
This fear of infection may cause tense couple relationships, as it raises questions about fidelity within the couple. One study from Singapore showed that approximately one in seven men, who were examined in a sexually transmitted infection clinic, had only pearly penile papules and no infection.
The level of patient concern appears to be related to the size of the papules. According to a study, two-thirds of males with moderate-to-large pearly penile papules have concerns about their lesions, while one-third of those with less-noticeable papules are worried.
Penile pearly papules are flesh-colored or white, dome-shaped or filiform papules. Their size ranges from 1 mm to 4 mm. Pearly penile papules are arranged in rows around the corona of the glans penis, mainly on its dorsal aspect. There can be one row or many rows. The papules may encircle the entire glans and even have ectopic locations on the penile shaft. The differential diagnosis includes genital warts, molluscum contagiosum, lichen nitidus, and sebaceous hyperplasia of the penis.
Genital warts are viral tumors induced by human papillomavirus. However, no viral particles are found in pearly penile papules. Molluscum contagiosum may be located on the penis as a sexually transmitted infection. However, these lesions have a larger size and are umbilicated in their center. They rarely have an exclusive location on the corona of the glans. Lichen nitidus may be limited to the genital area. It manifests as small translucent papules which may involve the glans.
However, lichen nitidus lesions are smaller and are usually not limited to the corona of the glans. Sebaceous hyperplasia is usually seen on the face, but rare cases of penile location were reported. Lesions usually occur on the ventral aspect of the penile shaft and are white to yellow papules. On dermoscopic examination, penile pearly papules are arranged according to a grape-like or a cobblestone pattern.
They exhibit a white or pink color, with central comma-like, hairpin, or dotted vessels. Such a vascular pattern is not specific, as it may be observed in genital warts. However, pearly penile papules, unlike genital warts, do not show desquamation which manifests as an irregular reflection. Histopathologically, pearly penile papules share the same features as angiofibroma.
Microscopic examination shows an acanthotic epidermis, with elongated rete ridges, overlying dilated vessels located in the papillary dermis. There is usually a dermal proliferation of stellate fibroblasts and a marked concentric fibrosis. Because of the benign nature of pearly penile papules, as well as their possible resolution with age, treatment is not indicated. However, some patients feel distressed or have important cosmetic concerns. Furthermore, about a half of males who are reassured of the benign nature of their pearly penile papules want to remove them.
Some of them may use inappropriately over-the-counter topicals for common warts, which may cause injuries and scarring. Studies having assessed cryotherapy are scarce.
Two sessions of liquid nitrogen induced good cosmetic results with no pigmentation in a few patients. Practitioners may also use ablative lasers. Carbon dioxide laser vaporization leads to complete removal of pearly penile papules. This procedure is painful and requires local anesthesia. The vascularization of the penis may cause bleeding during laser sessions but also makes the reepithelialization faster, so that wound healing is achieved within a week. The post-procedure wound management may be inconvenient for patients.
Unlike continuous-wave and pulsed modes, fractionated carbon dioxide laser causes less tissue damage with fewer adverse effects, but it may require more than one treatment to achieve acceptable cosmetic results. One to six sessions of ablative nm erbium YAG laser cleared pearly penile papules in 45 males. Wounds healed within two weeks. Fractional nonablative nm erbium laser is less painful than ablative devices and produces only microscopic skin damage which heals rapidly.
Up to five treatment sessions were reported to be necessary to obtain a good cosmetic result. Pulsed dye laser may be indicated in pearly penile papules treatment, as it is reported to give good aesthetic results, with a few side effects after one to three sessions.
Pearly penile papules are benign lesions, and they undergo no malignant transformation. Physical treatments such as cryotherapy and laser should only be indicated in patients with significant psychological discomfort.
Pearly papules on the penis are best managed by an interprofessional team that includes nurses and pharmacists. Furthermore, about half of males who are reassured of the benign nature of their pearly penile papules want to remove them. Clinicians should educate patients that most treatments are likely to cause more harm than good. If patients persist, a urology consult should be sought for treatment options. Knowledge Base About. Pearly Penile Papule.
Article Author: Talel Badri. Michael Ramsey. Introduction Pearly penile papules, also known as papillomatosis corona penis, corona capillitii, hirsuties coronae glandis, papillae coronis glandis, and hirsutoid papillomas, are benign lesions of the penis. Etiology Pearly penile papules are considered normal anatomical variant. Pathophysiology The exact role of pearly penile papules is not clear to date.
History and Physical Although pearly penile papules are usually asymptomatic, they are often mistaken by males who carry them for genital warts, thus causing concerns of having a sexually transmitted infection. Evaluation Penile pearly papules are flesh-colored or white, dome-shaped or filiform papules. In the case of diagnostic difficulty, dermoscopy and histopathology are helpful tools. Pearls and Other Issues Pearly penile papules are benign lesions, and they undergo no malignant transformation.
Enhancing Healthcare Team Outcomes Pearly papules on the penis are best managed by an interprofessional team that includes nurses and pharmacists. Contributed by the E. Indian journal of sexually transmitted diseases and AIDS. Obstetrics and gynecology. JAMA dermatology. The Journal of family practice.
Diagnosis and Management of Pearly Penile Papules
Pearly penile papules are small pink-white growths that develop around the head of the penis. Any male can develop pearly penile papules, but they are not considered harmful. This article will discuss what pearly penile papules are, how to identify them, and whether they can be removed or prevented. The medical term used to describe pearly penile papules is Hirsutoid papillomas.
What Are Pearly Penile Papules?
Had rough bumps around your penis for the longest time? They are usually arranged circumferentially and they have the same colour as your skin. Pearly penile papules are actually a normal variant of the penile anatomy. Although they are often mistaken as sexually transmitted lesions.
Should I worry about pearly penile papules?
PPP are small, benign non-cancerous growths. They are not associated with any symptoms; they are not itchy or painful. They typically first appear in adolescence or early adulthood. They are estimated to occur in 1 in 7 to 1 in 2 males.