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eMedicine Journal
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Dermatology
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Benign Neoplasms
Pearly Penile Papules Synonyms, Key Words, and Related Terms: angiofibromas, hirsute papillary corona of the penis, hirsutoid papillomas, papillae of the corona of the glans, papillae of the corona of the glans penis, papillomatosis corona penis, Tyson glands, Tyson's glands, uncircumcised males, lesions of the sulcus of the glans penis, lesions of the corona of the glans penis |
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Author Information | Introduction | Clinical | Differentials | Workup | Treatment | Medication | Follow-up | Miscellaneous | Test Questions | Pictures | Bibliography
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 | AUTHOR INFORMATION | Section 1 of 12    |
Authored by Clarence William Brown, Jr, MD, Consulting Surgeon, Assistant Professor of Dermatology, Department of Dermatology, Rush-Presbyterian-St. Luke's Medical Center
Clarence William Brown, Jr, MD, is a member of the following medical societies: American Academy of Dermatology, and American College of Mohs Micrographic Surgery and Cutaneous Oncology
Edited by James Fulton, Jr, MD, PhD, Medical Director, Fulton Skin Institute; Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center; Lester F Libow, MD, Dermatopathologist, South Texas Dermatopathology Laboratory; Joel M Gelfand, MD, MSCE, Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania; and Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
| Author's Email: | Clarence William Brown, Jr, MD |  |
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| Editor's Email: | James Fulton, Jr, MD, PhD |
eMedicine Journal, October 5 2006, VOLUME 7,
Number 10
| INTRODUCTION | Section 2 of 12  |
Background: Pearly penile papules are small dome-shaped to filiform skin-colored papules that typically are located on the sulcus or corona of the glans penis. Commonly, lesions are arranged circumferentially in one or several rows and often are assumed wrongly to be transmitted sexually.
Pathophysiology: Pearly penile papules are considered a normal variant and harbor no malignant potential. They are not contracted or spread through sexual activity.
Lesions are observed more frequently in uncircumcised males; however, the mechanisms underlying their development remain unknown.
Frequency:
Mortality/Morbidity: Lesions are considered to be a normal variant and are unrelated to sexual activity. Often, lesions cause great anxiety to patients until their benign nature is clarified.
Race: No racial predilection has been confirmed.
Sex: Because of their anatomic distribution, pearly penile papules are noted only in men.
Age: Pearly penile papules are noted most commonly in males in their second or third decades of life, with a gradual decrease in frequency with aging.
| CLINICAL | Section 3 of 12 |
History:
Physical:
Causes:
| DIFFERENTIALS | Section 4 of 12 |
Molluscum Contagiosum
Warts, Genital
Other Problems to be Considered:
Condyloma acuminatum
Ectopic sebaceous glands
| WORKUP | Section 5 of 12 |
Procedures:
These features indicate angiofibroma and are not specific for pearly penile papules. Angiofibromas associated with tuberous sclerosis (adenoma sebaceum) and fibrous papule may show identical histologic findings. Clinical history or recognition of genital skin (in adequate biopsy sample) may provide a specific diagnosis.
| TREATMENT | Section 6 of 12 |
Medical Care:
Surgical Care:
Consultations:
Activity: Pearly penile papules are not associated with personal hygiene or sexual activity.
| MEDICATION | Section 7 of 12 |
No effective topical or oral medical therapies are known for the treatment of pearly penile papules.
| FOLLOW-UP | Section 8 of 12 |
Further Outpatient Care:
Deterrence/Prevention:
Prognosis:
Patient Education:
| MISCELLANEOUS | Section 9 of 12 |
Medical/Legal Pitfalls:
| TEST QUESTIONS | Section 10 of 12 |
CME Question 1: Pearly penile papules have been associated with which of the following etiologic agents?
A: Human papilloma virus
B: Molluscum contagiosum
C: Herpes simplex virus
D: Fournier gangrene
E: None of the above
The correct answer is E: Pearly penile papules are considered a benign anatomic variant, unrelated to any etiologic agent. Human papilloma virus is the etiologic agent that gives rise to genital warts (condyloma acuminatum). Molluscum contagiosum is caused by poxvirus. Herpes simplex lesions are characterized by grouped painful vesicles and erosions. Fournier gangrene is a necrotizing fasciitis of the perineum.
CME Question 2: Which of the following has been associated with a decreased incidence of pearly penile papules?
A: African American race
B: White race
C: Asian race
D: Circumcision
E: Age
The correct answer is D: Pearly penile papules have been observed in 22% of uncircumcised men and 12% of circumcised men.
Pearl Question 1 (T/F): Older men most commonly present to the office with pearly penile papules as their chief concern.
The correct answer is False: Pearly penile papules most commonly are diagnosed in men in their second and third decades of life, probably due, in part, to their heightened sense of self and sexuality.
Pearl Question 2 (T/F): A specific histopathologic feature can characterize pearly penile papules observed under the microscope.
The correct answer is True: Angiofibroma is a characteristic feature.
Pearl Question 3 (T/F): Condyloma acuminatum should be considered as a differential diagnosis of pearly penile papules.
The correct answer is True: Condyloma acuminatum (genital warts), which usually is responsive to topical ablation with podophyllin and cryotherapy, should be considered as a differential diagnosis. Also, molluscum contagiosum (which appears clinically as small, firm, umbilicated, flesh-colored papules usually on the penile shaft) and ectopic sebaceous glands (which appear similar to molluscum lesions) should be considered.
Pearl Question 4 (T/F): Pearly penile papules are seen most commonly in white men.
The correct answer is False: No racial predilection has been observed in men with pearly penile papules.
| PICTURES | Section 11 of 12 |
| BIBLIOGRAPHY | Section 12 of 12 |
| NOTE: |
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| Medicine is a constantly changing science and not all therapies are clearly established. New research changes drug and treatment therapies daily. The authors, editors, and publisher of this journal have used their best efforts to provide information that is up-to-date and accurate and is generally accepted within medical standards at the time of publication. However, as medical science is constantly changing and human error is always possible, the authors, editors, and publisher or any other party involved with the publication of this article do not warrant the information in this article is accurate or complete, nor are they responsible for omissions or errors in the article or for the results of using this information. The reader should confirm the information in this article from other sources prior to use. In particular, all drug doses, indications, and contraindications should be confirmed in the package insert. FULL DISCLAIMER |
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Author Information | Introduction | Clinical | Differentials | Workup | Treatment | Medication | Follow-up | Miscellaneous | Test Questions | Pictures | Bibliography
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