Pearly penile papules
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Pearly penile papules (PPP) are benign small bumps on the
human penis The human penis is an external male intromittent organ that additionally serves as the urinary duct. The main parts are the root (radix); the body (corpus); and the epithelium of the penis including the shaft skin and the foreskin (prepuce) co ...
. They vary in size from 1–4 mm, are pearly or flesh-colored, smooth and dome-topped or filiform, and appear in one or several rows around the
corona Corona (from the Latin for 'crown') most commonly refers to: * Stellar corona, the outer atmosphere of the Sun or another star * Corona (beer), a Mexican beer * Corona, informal term for the coronavirus SARS-CoV-2, which causes the COVID-19 di ...
, the ridge of the head of the penis and sometimes on the penile shaft. They are painless, non-cancerous and not harmful.


Symptoms and signs

PPPs are small bumps on the
human penis The human penis is an external male intromittent organ that additionally serves as the urinary duct. The main parts are the root (radix); the body (corpus); and the epithelium of the penis including the shaft skin and the foreskin (prepuce) co ...
. They vary in size from 1–4 mm, are pearly or flesh-colored, smooth and dome-topped or filiform, and appear in one or several rows around the
corona Corona (from the Latin for 'crown') most commonly refers to: * Stellar corona, the outer atmosphere of the Sun or another star * Corona (beer), a Mexican beer * Corona, informal term for the coronavirus SARS-CoV-2, which causes the COVID-19 di ...
, the ridge of the
glans The glans (, plural "glandes" ; from the Latin word for "acorn") is a vascular structure located at the tip of the penis in male mammals or a homologous genital structure of the clitoris in female mammals. Structure The exterior structure ...
and sometimes on the penile shaft. They are painless, non-cancerous and not harmful.


Cause and mechanism

PPPs are a type of
angiofibroma Angiofibroma (AGF) is a descriptive term for a wide range of benign skin or mucous membrane (i.e. the outer membrane lining body cavities such as the mouth and nose) lesions in which individuals have: 1) benign papules, i.e. pinhead-sized elevation ...
. Their function is not well-understood. They are sometimes described as vestigial remnants of
penile spines Many mammalian species have developed keratinized penile spines along the glans and/or shaft, which may be involved in sexual selection. These spines have been described as being simple, single-pointed structures (macaques) or complex with two ...
, sensitive features found in the same location in other primates. PPPs secrete oil that moistens the glans of the penis. They do not spread and often spontaneously regress. Along with Fordyce glands PPPs secrete oils to keep the skin of the head of penis in good condition.
Smegma Smegma (Ancient Greek σμῆγμα : ''smēgma'') is a combination of shed skin cells, skin oils, and moisture. It occurs in both male and female mammalian genitalia. In females, it collects around the clitoris and in the folds of the labia ...
can accumulate if these oils are produced in excess or there is inadequate washing under the foreskin.


Diagnosis

Diagnosis is by visualisation. On
dermoscopy Dermatoscopy also known as dermoscopy or epiluminescence microscopy, is the examination of skin lesions with a dermatoscope. It is a tool similar to a camera to allow for inspection of skin lesions unobstructed by skin surface reflections. The de ...
, the white-pink papules appear in a cobblestone-like pattern and contain a central dotted or comma-shaped blood vessels. There is no scale. PPPs are sometimes mistaken for
genital warts Genital warts are a sexually transmitted infection caused by certain types of human papillomavirus (HPV). They are generally pink in color and project out from the surface of the skin. Usually they cause few symptoms, but can occasionally be pai ...
due to a perceived similarity in appearance. They can also appear similar to
molluscum contagiosum Molluscum contagiosum (MC), sometimes called water warts, is a viral infection of the skin that results in small raised pink lesions with a dimple in the center. They may become itchy or sore, and occur singularly or in groups. Any area of the sk ...
,
sebaceous hyperplasia Sebaceous hyperplasia is a disorder of the sebaceous glands in which they become enlarged, producing flesh-colored or yellowish, shiny, often umbilicated bumps on the face. Newly formed nodules often swell with sweating (which is pathognomonic for ...
and
lichen nitidus Lichen nitidus is a chronic inflammatory disease of unknown cause characterized by 1–2 mm, discrete and uniform, shiny, flat-topped, pale flesh-colored or reddish-brown papules that may appear as hypopigmented against dark skin. Occasion ...
. Histopathology shows dense
connective tissue Connective tissue is one of the four primary types of animal tissue, along with epithelial tissue, muscle tissue, and nervous tissue. It develops from the mesenchyme derived from the mesoderm the middle embryonic germ layer. Connective tiss ...
,
fibroblasts A fibroblast is a type of biological cell that synthesizes the extracellular matrix and collagen, produces the structural framework ( stroma) for animal tissues, and plays a critical role in wound healing. Fibroblasts are the most common cells o ...
and many blood vessels.


Treatment

Generally, reassurance is given and no treatment is needed. Laser or cryotherapy may be considered for men who find PPPs distressing to look at or feel excessive embarrassment.
Carbon dioxide laser The carbon-dioxide laser (CO2 laser) was one of the earliest gas lasers to be developed. It was invented by Kumar Patel of Bell Labs in 1964 and is still one of the most useful types of laser. Carbon-dioxide lasers are the highest-power continuou ...
generally has good outcomes with skin healing within seven days. The procedure requires anaesthesia, may need to be performed more than once, and has a risk of bleeding, scarring and colour changes. Another procedure involves a
hyfrecator A hyfrecator is a low-powered medical apparatus used in electrosurgery on conscious patients, usually in an office setting. It is used to destroy tissue directly, and to stop bleeding during minor surgery. It works by emitting low-power high-frequ ...
.


Epidemiology

PPPs are common and occur in 14% to 48% of young males. They are less common in
circumcised Circumcision is a procedure that removes the foreskin from the human penis. In the most common form of the operation, the foreskin is extended with forceps, then a circumcision device may be placed, after which the foreskin is excised. Topic ...
males, occurring about half as frequently in circumcised men.


Social and cultural

Some men find PPPs distressing to look at, owing to their resemblance to some sexually transmitted infections. Although it is not related to any
disease A disease is a particular abnormal condition that negatively affects the structure or function of all or part of an organism, and that is not immediately due to any external injury. Diseases are often known to be medical conditions that a ...
, PPPs are occasionally mistaken for HPV warts. There are also
home remedies Traditional medicine (also known as indigenous medicine or folk medicine) comprises medical aspects of traditional knowledge that developed over generations within the folk beliefs of various societies, including indigenous peoples, before the ...
for "curing" it, despite the fact that the papules are neither infectious nor detrimental to one's health and may have beneficial functions. Some of the "home remedies" found on the Internet and elsewhere use mild ointments or creams to soften the papules, but others are physically dangerous techniques for papule removal which can result in irreversible damage. Rapini ''et al.'' advise that, since dermatologists have safe, effective ways to remove the papules if desired, home remedies involving corrosive substances or self-surgery should be avoided, since they can permanently damage sexual functioning. Rapini ''et al.'' further state that removal should only be performed by a physician using proven medical techniques.


References


External links

{{DEFAULTSORT:Hirsuties Papillaris Genitalis Dermal and subcutaneous growths Human penis anatomy Andrology Human male reproductive system