Pearly penile papules are small cone-shaped protruding formations of the skin around the head or crown groove of the penis without a tendency to ulceration, inflammation or malignancy. These outgrowths are considered as a variant of the norm. Pearl papules do not cause any unpleasant symptoms. The diagnosis is established on the basis of a visual examination, if in doubt, dermatoscopy and biopsy with subsequent morphological examination are possible. Treatment is not a prerequisite and is performed exclusively for cosmetic purposes. Destruction options include laser surgery, cryotherapy, and radiosurgery.
ICD 10
D29.0
General information
Pearly penile papules (synonyms: hirsutoid papillomas, pearl papillary papules, papillary crown of the penis, etc.) usually develop after puberty. The prevalence is estimated at 14-48%, higher in black and uncircumcised men. After the appearance of papules, they remain for life, do not tend to change shape and spread to other parts of the body. They may decrease in size with age. Given their similarity to some pathological conditions, it is recommended to consult a dermatovenerologist or urologist. Hirsutoid papillomas are not contagious and do not affect a man’s sex life. There is evidence of increased sensations during sexual intercourse in a partner.
Causes
It is not known for certain why a papillary crown appears on the penis. It is assumed that papules remain after human embryonic development in the womb. Although the exact cause is unclear, experts in the field of urology and andrology claim that pearly papules are a normal anatomical condition that is registered mainly in men 20-40 years old. No risk factors have been established, papillary formations are not associated with hygiene or sexual activity. Two theories related to pearl-penile papules are considered:
- Rudimentary theory. Ancient man and apes had soft growths on the penis. In the process of evolution, most men have lost this feature. To date, mother-of-pearl papules are considered rudimentary remnants – an inheritance from ancestors.
- Theory of hair follicle changes. The hypothesis is that the cause of the pearly penile papules are large modified hair follicles, but convincing evidence of this has not yet been presented. Opponents of this theory argue that hair follicles are located throughout the body, but hirsutoid papillomas have a clear localization limited to the head of the penis.
Pathogenesis
The pathogenesis of pearlescent papules of the genital organ has not been fully studied. Scientists do not know why the proliferation of fibroblasts with concentric fibrosis begins in the skin and the expansion of blood vessels feeding papules (by the type of angiofibroma). Perhaps a certain role belongs to the accumulation of smegma, which has carcinogenic properties and can provoke the development of neoplasms. There is no convincing evidence, but there is evidence that penile papules are 2 times less common in men with circumcision surgery. It is also noticed that after circumcision of the foreskin, the regression of papules begins.
Symptoms
Most men mistake pearl papules for a sexually transmitted disease, which makes them turn to a dermatovenerologist. There are no specific symptoms. On examination, the following picture is typical: along the circumference around the coronal furrow, cone-shaped filamentous growths of a solid or yellowish-cream hue are densely arranged in one or two rows, painless when pressed. The size is variable: from 1 to 4 mm. In order to see them, it is necessary to expose the head of the penis. In men, after circumcision, pearlescent papules are located in the same areas. Hyperemia, keratosis are not characteristic, as well as an increase in inguinal lymph nodes.
Complications
If you do not take independent actions related to the traumatization of papules (chemical treatment, tweezing), complications are not typical. General adverse effects in rare cases may develop after surgical destruction and may be represented by loss of sensitivity, secondary infection, bleeding, which may require additional manipulations. Often, edema and hyperemia accompany the treatment with podophyllotoxin, therefore, other methods of getting rid of this cosmetic defect are currently preferred. Active application of various creams and ointments, cauterization with iodine, alcohol, etc. can lead to the development of dermatitis.
Diagnostics
In most clinical cases, it is possible to establish a diagnosis after a visual examination already during the initial consultation of a venereologist or urologist. Carrying out any laboratory tests confirming the condition is not provided. If you suspect a different genesis of growths, they can be useful:
- Dermatoscopy. Dermatoscopic examination allows you to examine suspicious areas under multiple magnification. This is relevant for the diagnosis of a contagious mollusk, which has some similar manifestations. The examination is not mandatory and, despite its absolute non-invasiveness, is not carried out for all patients.
- Biopsy with histology. After a chemical burn or injury to the papules, ulcerative necrotic lesion is visualized in some men. It is impossible to determine its genesis without additional diagnostic methods. Mother-of-pearl papules of the skin of the male organ do not exclude the possibility of a combined development of the tumor process, although these nosologies are not related.
Differential diagnosis is performed with genital warts, contagious mollusc, ectopic sebaceous glands. Of the above, the greatest danger is acuminate warts (genital genital warts), which can be transmitted sexually and are associated with the initiation of the tumor process. In appearance, they are less uniform in shape and size, with uneven contours, are not arranged in clear circular rows and may change over time. When infected with a contagious mollusk, the damage is larger, concave, sometimes with a pink tinge. Ectopic sebaceous glands are localized on the roll of the penis, yellowish in color and secrete a fatty secret. Some specialists include Fordyce spots, angioceratomas, folliculitis and scabies in the differential diagnosis.
Pearly penile papules treatment
If a man experiences psychological discomfort due to the presence of multiple pearl papules, it is possible to carry out treatment for cosmetic purposes. Simple excision with a scalpel is too traumatic, fraught with scarring with loss of sensitivity, therefore it is not recommended for use. The same can be attributed to all kinds of methods of chemical destruction. There are no oral medications for treatment. To remove pearl papules with minimal risk of complications, you can use:
- Laser ablation. Laser treatment is the most modern, effective and painless treatment. The procedure does not require deep anesthesia, has high cosmetic results with the fastest possible recovery. After pinpoint exposure to each formation, the papule splits at the molecular level and evaporates, leaving no scars and not affecting the adjacent skin. This is facilitated by the high accuracy of the laser beam.
- Cryodestruction. Papules are frozen several times with liquid nitrogen (temperature -60 ° C), which causes the destruction of cells and the gradual death of growths. The effect of exposure manifests itself within 10-12 days. The skin turns white after treatment, a painful bubble forms, which is transformed into a crust as the healing processes take place. After the crust falls off, residual pigmentation is possible.
- Radiosurgery. High-dose radiation is used for selective ionization of tissue, as a result of which free radicals are released, which have a destructive effect on cells. To remove the pearlescent papules of the penis, this procedure is preferable to a simple surgical operation, but inferior to laser surgery.
- Electrocoagulation. With the help of an electric coagulator, the papules are dried as much as possible, after which the residual tissues are removed with surgical instruments. The method requires anesthesia and may be complicated by permanent scarring. After the intervention, the pain syndrome is stopped by the appointment of analgesics.
Prognosis and prevention
After a conversation with explanations of the benign formations, the absence of the risk of infection and complications, many men agree with the uselessness of any therapeutic actions. A doctor’s conversation with a partner about the safety of papules is a good moral support. The prognosis for life is favorable. Circumcision at birth can reduce the likelihood of developing pearlescent papules by 50%, but do not consider hirsutoid papillomas as an indication for this operation. Given the probable role of smegma in the development of penile neoplasms, do not forget about adequate hygienic care: hygienic procedures are carried out at least once a day with mandatory removal of smegma.