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 (see the images below) and commonly are arranged circumferentially in one or several rows. [1] Although pearly penile papules often are wrongly assumed to be transmitted sexually, they 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.
Pathophysiology
Pearly penile papules are considered a normal variant and harbor no malignant potential. They are not contracted or spread through sexual activity. In the past, pearly penile papules were believed to contribute to the accumulation of smegma in uncircumcised men; however, subsequent study showed that this is not the case. [2]
Pearly penile papules are observed more frequently in uncircumcised males than in circumcised males; however, the mechanisms underlying their development remain unknown. It is noteworthy that in uncircumcised males with pearly penile papules who undergo circumcision later in life, regression of the papules is commonly observed. [3]
Epidemiology
United States and international statistics
The reported incidence of pearly penile papules in the United States has been in the range of 8-48%. [4] As noted, several reports have suggested that the incidence is higher in uncircumcised men than in circumcised men (22% vs 12%). One study found an increase in frequency in Black men as compared with White men. [5]
No geographic variations in prevalence have been noted for pearly penile papules.
Age-, sex-, and race-related demographics
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. [3]
Because of their anatomic distribution, pearly penile papules are noted only in males. However, hirsutoid papillomas of the vulvae (also known as vestibular papillomatosis) is a benign, asymptomatic anatomic variant of the vulvar epithelium that is present in approximately 1% of women. [6] It is considered the female counterpart of pearly penile papules in men. [7]
No racial predilection has been definitively confirmed for pearly penile papules. There have been reports suggesting an increased incidence in African American males, but this finding may be a reflection of a higher percentage of uncircumcised men in that population. In a study that included 840 men aged 10-66 years, the overall incidence of pearly penile papules was 30.1%. [5] Among the Black study subjects, the incidence of pearly penile papules was 32.7% (44% in uncircumcised subjects and 20.8% in circumcised subjects); among the White study subjects, the incidence was 13.9% (33.3% in uncircumcised subjects and 7.1% in circumcised subjects).
Prognosis
Pearly penile papules typically are asymptomatic and persist throughout life, though the lesions may gradually become less noticeable with advancing age.
Patient Education
It is important to educate patients about the benign nature of pearly penile papules. Patients should be informed that the papules are not transmitted through sexual activity. It may be worthwhile to suggest that the patient's sexual partner consider counseling, which often helps alleviate anxiety.
-
Pearly penile papules are seen clinically as multiple glistening, flesh-colored, dome-topped papules arranged circumferentially in two rows along corona of glans penis.
-
Pearly penile papules. Image from Wikimedia Commons.
-
Pearly penile papules: close-up view. Image from Wikimedia Commons.
