Indian Journal of Dermatology
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Year : 2014  |  Volume : 59  |  Issue : 4  |  Page : 424
Eruptive angiokeratomas on the glans penis


Department of Dermatology, STD and Leprosy, Government Medical College and Associated SMHS Hospital, Srinagar, Kashmir (J & K), India

Date of Web Publication27-Jun-2014

Correspondence Address:
Mohammad Abid Keen
Department of Dermatology, STD and Leprosy, Government Medical College and Associated SMHS Hospital, Srinagar, Kashmir (J & K)
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.135561

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How to cite this article:
Keen MA, Hassan I. Eruptive angiokeratomas on the glans penis. Indian J Dermatol 2014;59:424

How to cite this URL:
Keen MA, Hassan I. Eruptive angiokeratomas on the glans penis. Indian J Dermatol [serial online] 2014 [cited 2019 Jun 18];59:424. Available from: http://www.e-ijd.org/text.asp?2014/59/4/424/135561


Sir,

Angiokeratomas are benign cutaneous vascular lesions characterized by dilated thin-walled blood vessels lying in the upper dermis, associated with an epidermal reaction such as acanthosis and hyperkeratosis. Several clinical variants of angiokeratomas exist: the Mibelli type, the Fordyce type, the solitary and multiple (papular type), the angiokeratoma circumscriptum and the angiokeratoma corporis diffusum. A case of multiple angiokeratomas of glans in an adult male is reported in view of the clinical rarity of this location.

A 42-year-old married man presented with multiple reddish blue papular lesions on corona of glans penis since 8 months. These lesions had started abruptly as small, reddish blue spots and had gradually increased in size and became bluish with time. These lesions were asymptomatic and he had not received any kind of treatment. There was no history of the high risk behavior in the patient. Cutaneous examination revealed multiple, firm, non-tender, bluish purple hyperkeratotic papules ranging in size from 0.5 mm to 3 mm encircling the coronal arc of glans penis [Figure 1]. There was no involvement of the scrotum and inguinal lymphadenopathy was absent. Palpation ruled out varicocele, epididymal mass or inguinal hernia. A punch biopsy from one of the papules revealed dilated blood vessels in the upper dermis, epidermal hyperkeratosis and enlargement of rete ridges [Figure 2]. Ultrasonography of abdomen, pelvis and scrotum were performed to rule out any vascular anomaly. A diagnosis of angiokeratoma of glans penis was made on the basis of the clinical features and histopathology.
Figure 1: Multiple, bluish purple hyperkeratotic papules ranging in size from 0.5 mm to 3 mm

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Figure 2: (H and E, ×10) showing dilated blood vessels in the upper dermis, epidermal hyperkeratosis and enlargement of rete ridges

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Angiokeratomas are benign proliferations of dilated thin-walled blood vessels in the upper dermis with overlying epidermal hyperkeratosis. [1] Angiokeratomas are typically asymptomatic, 2-5 mm, blue to red papules with a scaly surface. Angiokeratomas can be classified into five principal types:

  1. Angiokeratoma of Mibelli, reported by Bazin in 1862 and defined by Mibelli in 1889, characterized by papules or verrucoid nodules, more commonly in men and involving bony prominences [2]
  2. Angiokeratoma of Fordyce, described by Fordyce in 1896, common in elderly males, located in scrotum, thighs, abdomen and groins and vulva in women, usually related to conditions with elevated venous pressure [3]
  3. Angiokeratoma circumscriptum, first reported by Fabry in 1915, usually presenting as papules with a tendency to confluence into plaques [4]
  4. Solitary or multiple (papular) types, usually involving lower extremities
  5. Angiokeratoma corporis diffusum, consisting of multiple papules in clusters, usually associated with Anderson Fabry's disease.


Angiokeratoma of Fordyce consists of small 1-4 mm, bright red vascular hyperkeratotic papules usually seen on scrotum. Similar lesions have been reported on the penile shaft, upper thigh, glans penis, oral mucosa and prepuce. [5] Isolated lesions on glans penis as observed in our patient are rare.

Individual lesions are bright red-purple to black, round to oval hyperkeratotic papules. These are usually asymptomatic, but can occasionally cause bleeding with slight trauma, pruritus and pain. [6] The exact etiology remains unknown, but increased local venous hypertension and degeneration of elastic tissue in dilated vessels are hypothesized as causal. Although there is no established protocol for the management of angiokeratomas involving the glans penis, excellent cosmetic results with the use of combined treatment with Erbium-YAG and 532 nm potassium-titanyl-phosphate laser have been described. [7]

 
   References Top

1.Feramisco JD, Fournier JB, Zedek DC, Venna SS. Eruptive angiokeratomas on the glans penis. Dermatol Online J 2009;15:14.  Back to cited text no. 1
    
2.Sahin MT, Türel-Ermertcan A, Oztürkcan S, Türkdogan P. Thrombosed solitary angiokeratoma of Mibelli simulating malignant melanoma: The importance of dermoscopy in differential diagnosis. J Eur Acad Dermatol Venereol 2006;20:102-4.  Back to cited text no. 2
    
3.Carrasco L, Izquierdo MJ, Fariña MC, Martín L, Moreno C, Requena L. Strawberry glans penis: A rare manifestation of angiokeratomas involving the glans penis. Br J Dermatol 2000;142:1256-7.  Back to cited text no. 3
    
4.Saha M, Barlow R, Bunker CB. Angiokeratoma circumscriptum of the penis. Br J Dermatol 2006;154:775-6.  Back to cited text no. 4
    
5.Imperial R, Helwig EB. Angiokeratoma of the scrotum (Fordyce type). J Urol 1967;98:379-87.  Back to cited text no. 5
    
6.Taniguchi S, Inoue A, Hamada T. Angiokeratoma of Fordyce: A cause of scrotal bleeding. Br J Urol 1994;73:589-90.  Back to cited text no. 6
    
7.Bechara FG, Jansen T, Wilmert M, Altmeyer P, Hoffmann K. Angiokeratoma Fordyce of the glans penis: Combined treatment with erbium: YAG and 532 nm KTP (frequency doubled neodynium: YAG) laser. J Dermatol 2004;31:943-5.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2]



 

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