Derm Dx: Violaceous Papules on the Genitalia - Clinical Advisor

Derm Dx: Violaceous Papules on the Genitalia

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A 62-year-old man presents for evaluation of contact dermatitis on his arms. Unrelated to this condition, he states that he is curious to know the cause of “purplish pimples” on his penis. These have been present for years and have never bled. Examination reveals a trio of violaceous papules. Scattered angiomas and keratoses are noted on his back.

Can you diagnose this condition?

Angiokeratomas of the male genitalia (also known as angiokeratomas of Fordyce) most commonly present on the scrotum bilaterally.1 Lesions range in color from red to dark blue. The condition usually arises in middle-aged to elderly men and is asymptomatic and...

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Angiokeratomas of the male genitalia (also known as angiokeratomas of Fordyce) most commonly present on the scrotum bilaterally.1 Lesions range in color from red to dark blue. The condition usually arises in middle-aged to elderly men and is asymptomatic and benign. Patients may express concern about more serious pathology. The etiology is uncertain, although localized venous hypertension has been postulated.2

Angiokeratomas of the penis are rarely encountered. These present on the coronal rim of the glans and are often multiple in number.3,4 Dermoscopy may be useful when the differential includes melanoma. If desired, removal by laser is an effective therapeutic modality.5

Stephen Schleicher, MD, is director of the DermDox Center for Dermatology, as well as an associate professor of medicine at Commonwealth Medical College and a clinical instructor of dermatology at Arcadia University and Kings College.

References

1. Imperial R, Helwig EB. Angiokeratoma of the scrotum (Fordyce type). J Urol. 1967;98(3):379-387.

2. Erkek E, Basar MM, Bagci Y, Karaduman A, Bilen CY, Gokoz A. Fordyce angiokeratomas as clues to local venous hypertension. Arch Dermatol. 2005;141(10):1325-1326.

3. Beutler BD, Cohen PR. Angiokeratoma of the glans penis. Skinmed. 2017;15(5):343–347.

4. Basu P, Cohen PR. Penile angiokeratoma (peaker): a distinctive subtype of genital angiokeratoma. Cureus. 2018;10(12):e3793.

5. Baumgartner J, Šimaljaková M. Genital angiokeratomas of Fordyce 595-nm variable-pulse pulsed dye laser treatment. J Cosmet Laser Ther. 2017;19(8):459–464.

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