What is Pearly Penile Papule?
Pearly penile papules, also known by several other names such as papillomatosis corona penis, corona capillitii, hirsuties coronae glandis, papillae coronis glandis, and hirsutoid papillomas, are harmless growths on the penis.
What Causes Pearly Penile Papule?
Pearly penile papules are seen as a normal variation of the body’s anatomy.
Risk Factors and Frequency for Pearly Penile Papule
Pearly penile papules, or small bumps on the penis, are a pretty common condition among men, but the rates can vary. They are seen in about 14% to 48% of males. These papules are usually found in young men, during late adolescence and early adulthood. As men grow older, the papules tends to lessen or disappear. These types of papules have not been found to occur in women.
Studies have shown that men who have been circumcised are generally less likely to have these papules. There’s a belief that it’s due to the protection the foreskin provides against constant irritation which may cause the papules to recede. However, some studies, like one by a researcher named Rehbein, even found the opposite – that it’s more common in circumcised men. In fact, a recent study found that amongst young men who had been circumcised, about 17.1% had these papules.
While most studies haven’t found a link between race and the likelihood of developing pearly penile papules, Rehbein’s research indicated that they are more common among African American males.
Signs and Symptoms of Pearly Penile Papule
Pearly penile papules are harmless skin growths on the penis. They usually don’t cause any symptoms. However, men who have them often confuse them with genital warts, which can lead to worries about having a sexually transmitted infection. This fear can create tension in relationships because it can raise doubts about fidelity. According to a study in Singapore, about one in seven men who visited a sexual health clinic only had pearly penile papules, not any infection.
The size of the papules can impact the level of worry a patient has. Research has found that two-thirds of men with medium-to-large pearly penile papules are worried about the growths. In contrast, only one-third of men with less noticeable papules express concern.
Testing for Pearly Penile Papule
Penile pearly papules are tiny flesh-colored or white bumps that can appear on the penis. These bumps are usually arranged in rows around the edge of the head of the penis, and they can cover the whole area or just parts of it. You might see just one row of these bumps, or there could be several. Sometimes, these bumps can even appear on the penis shaft.
There are several conditions that these papules could be mistaken for, such as genital warts, molluscum contagiosum, lichen nitidus, and sebaceous hyperplasia of the penis.
Genital warts are caused by a virus, but no virus particles are found in penile pearly papules. Both conditions can exist at the same time, and about 1% of males with penile pearly papules might also have genital warts.
Molluscum contagiosum is another condition that might be found on the penis due to a sexually transmitted infection. These lesions are bigger and have a small dent or ‘umbilication’ in their center. They don’t usually appear only on the corona (the edge of the head of the penis).
Lichen nitidus may show up only in the genital area, appearing as small see-through bumps that can involve the penis head. However, lichen nitidus lesions are smaller and are usually not limited to the edge of the penis head.
Sebaceous hyperplasia usually appears on the face but can occasionally be found on the penis. These bumps tend to be on the underside of the penis shaft and are white to yellow in color.
If it is not clear what these bumps are, dermoscopy (a close-up examination of the skin) and histopathology (microscopic examination of tissue) can be very helpful.
Through a dermoscope, these papules look like a pattern of grapes or cobblestones. They appear white or pink, with a comma-like or dotted pattern of tiny blood vessels in the center. This pattern is not exclusive to penile pearly papules and can also be seen in genital warts. However, these papules don’t show desquamation, which is irregular reflection and is seen in genital warts.
Under a microscope, these bumps show similar characteristics to angiofibroma, which is a benign skin lesion. There is usually a growth of star-shaped cells known as fibroblasts and sharply defined fibrosis, which is the formation of excess fibrous tissue.
Treatment Options for Pearly Penile Papule
Pearly penile papules are harmless, and often fade away with time, so treatment is usually not needed. However, some men might feel uncomfortable or be worried about their appearance. Even after being reassured that the condition is not harmful, about half of these men still wish to have them removed. It’s important to note that using over-the-counter treatments intended for common warts is not recommended, as this can cause injuries and scarring.
If removal is preferred, the papules can be treated with either cryotherapy (freezing off the papules) or laser therapy.
The use of cryotherapy is not widespread, but a few patients who have received two sessions of liquid nitrogen treatment showed good aesthetic results, without changes to their skin color.
Another option is laser treatment, specifically carbon dioxide laser vaporization, which completely removes the papules. However, this procedure can be quite painful, requiring local anesthesia, and may also lead to minor bleeding. While the wounds tend to heal within a week, the follow-up wound care can be challenging for patients. It’s also worth noting that there is a risk of scarring or changes in skin color.
Using a fractionated carbon dioxide laser might cause less damage to the tissue and fewer side effects but may require multiple treatments to achieve satisfactory results.
In a study with 45 men, an ablative 2940 nm erbium YAG laser treatment cleared pearly penile papules in one to six sessions. The wounds healed within two weeks and, after a year, there were no cases of recurrences, scarring, or change in skin pigmentation.
Alternatively, the use of a fractional nonablative 1550 nm erbium laser is less painful and only causes minor skin damage that heals quickly. Up to five treatment sessions might be necessary to achieve the desired cosmetic result.
Pulsed dye laser could also be an option for the treatment of pearly penile papules, as it reportedly delivers good aesthetic results with few side effects, typically after one to three sessions.
What else can Pearly Penile Papule be?
There are different skin conditions that you might encounter, such as:
- Genital warts
- Molluscum contagiosum
- Sebaceous hyperplasia
