Derm Dx: Multiple white papules on the penis - Clinical Advisor

Derm Dx: Multiple white papules on the penis

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A 30-year-old African-American man is evaluated for lesions on his penis. He states that the lesions have been present since adolescence, and he has had 2 work-ups for sexually transmitted diseases. He denies symptoms. Recent rapid plasma reagin and HIV assays were negative, and a complete blood count is unremarkable. Treatment with imiquimod cream did not produce any visible result. Examination reveals multiple 1-mm white papules on the glans penis. A few papules are also noted on the shaft.

Penile pearly papules are pearly white, dome-shaped papules located on the coronal margin and sulcus of the penis. They were first described and named in 1964.1 Lesions are small (usually 1 mm in size) and asymptomatic. Incidence ranges from less...

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Penile pearly papules are pearly white, dome-shaped papules located on the coronal margin and sulcus of the penis. They were first described and named in 1964.1 Lesions are small (usually 1 mm in size) and asymptomatic. Incidence ranges from less than 10% to greater than 40%; one study of men aged 18 to 66 years found an overall incidence of 30%, slightly higher in African-American men.2 Lesions most commonly arise in the second or third decades of life and may regress in later years.3

Penile pearly papules may contribute to anxiety in young adults. They are commonly encountered in sexually transmitted disease clinics and are often misdiagnosed as condyloma.4 As lesions are asymptomatic and not contagious, treatment is rarely indicated except to allay anxiety and afford better cosmesis. Lesions respond to electrodessication or laser ablation.5,6


Stephen Schleicher, MD, is an associate professor of medicine at the Commonwealth Medical College in Scranton, Pennsylvania, and an adjunct assistant professor of dermatology at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. He practices dermatology in Hazleton, Pennsylvania.

References

  1. Johnson BL Jr, Baxter DL. Pearly penile papules. Arch Dermatol. 1964;90:166-167.
  2. Rehbein HM. Pearly penile papules: incidence. Cutis. 1977;19(1):54-57.
  3. Agha K, Alderson S, Samraj S, et al. Pearly penile papules regress in older patients and with circumcision. Int J STD AIDS. 2009;20(11):768-770.
  4. Monroe JR. Does this man have genital warts? Pearly penile papules. JAAPA. 2009;22(2):16. 
  5. Lane JE, Peterson CM, Ratz JL. Treatment of pearly penile papules with CO2 laser. Dermatol Surg. 2002;28(7):617-618.
  6. Gan SD, Graber EM. Treatment of pearly penile papules with fractionated CO2 laser. J Clin Aesthet Dermatol. 2015; 8(5):50-52.
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