A 19-year-old man was referred for treatment of multiple papular lesions that had appeared 8 years earlier on the glans of his circumcised penis and had been diagnosed as condyloma accuminatum. The lesions did not respond to treatment with various topical wart preparations. The patient reported no history of sexually transmitted infections and was anxious and embarrassed by the lesions. A genital examination revealed multiple tiny, smooth, skin-colored papules (arrow), distributed circumferentially along the coronal sulcus of the glans penis. Pearly penile papules are asymptomatic acral angiofibromas, typically distributed circumferentially on the corona and sulcus of the glans penis. They are more frequently found in men after puberty, with a reported incidence rate as high as 35 percent. This normal variant is seen more commonly in black and circumcised men. Familiarity with such anatomical variants, which may resemble various dermatoses, helps to relieve anxiety in patients and prevent unnecessary treatments. Reproduced with permission from: Bylaite, M, Ruzicka, T. Pearly Penile Papules. N Engl J Med 2007; 357:691. Copyright ©2007 Massachusetts Medical Society.
Treatment
Medical Care
Pearly penile papules typically are asymptomatic and require no therapy.
Surgical Care
Some patients with pearly penile papules may request therapy to alleviate anxiety.
Ablation using carbon dioxide laser, cryosurgery, electrodesiccation with curettage, and excisional surgery reportedly have successfully eliminated pearly penile papules. Recent technological advancements in lasers have resulted in promising outcomes using newer fractional ablative approaches.
Topical application of podophyllin largely has been ineffective for pearly penile papules.
Consultations
Dermatologist: Consultation may prove useful when the diagnosis is not obvious.
Diet
Diet is not known to be a factor influencing the development or course of pearly penile papules.
Activity
Pearly penile papules are not associated with personal hygiene or sexual activity.
Medication
No effective topical or oral medical therapies are known for the treatment of pearly penile papules.
