Indian Journal of Dermatology
: 2015  |  Volume : 60  |  Issue : 3  |  Page : 325-

Multiple shiny papules on the shaft of the penis

Piyush Kumar1, Anupam Das2, Sushil S Savant1,  
1 Department of Dermatology, Katihar Medical College, Bihar, India
2 Department of Dermatology, Medical College and Hospital, Kolkata, India

Correspondence Address:
Piyush Kumar
Department of Dermatology, Katihar Medical College, Bihar

How to cite this article:
Kumar P, Das A, Savant SS. Multiple shiny papules on the shaft of the penis.Indian J Dermatol 2015;60:325-325

How to cite this URL:
Kumar P, Das A, Savant SS. Multiple shiny papules on the shaft of the penis. Indian J Dermatol [serial online] 2015 [cited 2019 Jul 21 ];60:325-325
Available from:

Full Text

A 26-year-old sexually active male presented to us with multiple, grouped, mildly itchy, tiny elevated lesions on the penis for 6 months. The lesions were static since their onset, without any increase in size and number. The patient has been married for last 2 years and has been in a monogamous relationship since then. Before presenting to us, the patient was treated for viral warts with topical podophyllin, but the lesions did not resolve. Cutaneous examination revealed small, flesh-colored, shiny, papules of around 2-3 mm in diameter on the shaft of the penis [Figure 1]. Inguinal lymph nodes and rest of the muco-cutaneous and systemic examinations were unremarkable. Complete hemogram and serum biochemistry panel did not reveal any abnormality. Besides, serology for Venereal Disease Research Laboratory (VDRL) and Human Immunodeficiency Virus (HIV) were non-reactive. The findings of histological examination of a papule are shown in [Figure 2]a-b.{Figure 1}{Figure 2}


What is your diagnosis?

 View AnswerAnswer

Ectopic pearly penile papules.


Pearly penile papules (PPP), also known as papillomatosis corona penis, Tyson's glands, corona capilliti, Hirsuties coronae glandis and hirsutoid papillomas, are now accepted as normal (physiological) variation of penis and are angiofibroma histopathologically. [1] Some authors consider these lesions as vestigial remnants of penile spines, which are found in the same location in other primates and contributes to sexual pleasure and quicker orgasms. [2] Vestibular papillomatosis is considered to be female equivalent of PPP and appears as diffuse granular papules or finger-like projections that are symmetrically distributed over the inner labia minora and vaginal introitus. [3]

PPP usually presents as one or several rows of small, flesh-colored, smooth, dome-topped to filiform papules (1 to 3 mm in size) situated circumferentially around the corona or sulcus of the glans penis; however, the lesions are most prominent on dorsal surface and show a tendency to fade somewhat as they approach the frenulum. [1],[2] Uncommonly, lesions may extend onto the glans penis. Lesions on the shaft of the penis are extremely rare. Such ectopic lesions are usually associated with typical coronal lesions, but may be the isolated finding on rare occasions. [4],[5] Our case had ectopic lesions on the shaft of the penis, but he had classical PPP lesions on corona too.

PPP are most commonly found in men between the ages of 20 and 40 years and they regress with age. [1] However, the lesion has been described in younger patients too. [4] The incidence of PPP reportedly ranges from 8% to 48% of male population. [6] The pathogenesis behind their development is not clear yet. However, they are common in uncircumcised males. In addition to this, the papules are found to regress following circumcision. [1],[7] Of note, human papillomavirus (HPV) has been shown to be absent in PPP lesions. [8] The lesions do not bear any importance in sexual activity but often, they pose a tremendous anxiety to sexually active patients compelling them to seek medical consultations. [1]

The common clinical differentials include condyloma acuminata, molluscum contagiosum, lichen nitidus and ectopic sebaceous glands. Histopathology is diagnostic and it reveals thin-walled ectatic dermal blood vessels in the background of proliferation of plump spindle-shaped stellate fibroblasts; which corroborates with a diagnosis of angiofibroma. Elastic and reticular fibers are absent and a sparse infiltrate of mast cells, plasma cells, lymphocytes, and histiocytes may be present in the papillary dermis. The epidermis in PPP shows orthokeratosis, hypergranulosis, and increased size and number of epidermal melanocytes with muted rete ridges. [9] Adenoma sebaceum (associated with tuberous sclerosis), oral fibroma, subungual and periungual fibroma, fibrous papule of the nose (face), and acquired acral angiofibroma are the other examples of cutaneous angiofibromas; which have been given distinct nomenclatures based on distinctive clinical presentation despite the fact that they share similar histopathology findings. [9],[10] However, less perivascular and periadnexal fibrosis, considered another characteristic of adenoma sebaceum, is less prominent. [10]

Masterly inactivity along with counseling regarding the benign nature of the condition is the best treatment modality which can be offered to the patients. However, some patients do not accept the condition and seek treatment. Options include ablative as well as fractional lasers, [1],[9],[10] electrodesiccation with curettage, excisional surgery, [9],[10] cryotherapy. [11] Recently, pulsed dye laser has been found to be an appropriate, effective, and nonablative method of treatment. [12]


1Michaj³owski I, Sobjanek M, Michaj³owski J, W³odarkiewicz A, Matuszewski M. Normal variants in patients consulted in the Dermatology Clinic for lesions of the male external genitalia. Cent European J Urol 2012;65:17-20.
2Oates JK. Pearly penile papules. Genitourin Med 1997;73:137-8.
3Fonder MA, Hunter-Yates J, Lawrence WD, Telang GH. Vestibular papillomatosis: A benign condition mimicking genital warts. Cutis 2012;90:300-1.
4Neri I, Bardazzi F, Raone B, Negosanti M, Patrizi A. Ectopic pearly penile papules: A paediatric case. Genitourin Med 1997;73:136.
5O'Neil CA, Hansen RC. Pearly penile papules on the shaft. Arch Dermatol 1995;131:491-2.
6Sonnex C, Dockerty WG. Pearly penile papules: A common cause of concern. Int J STD AIDS 1999;10:726-7.
7Agha K, Alderson S, Samraj S, Cottam A, Merry C, Lee V, et al. Pearly penile papules regress in older patients and with circumcision. Int J STD AIDS 2009;20:768-70.
8Ferenczy A, Richart RM, Wright TC. Pearly penile papules: Absence of human papillomavirus DNA by the polymerase chain reaction. Obstet Gynecol 1991;78:118-22.
9Agrawal SK, Bhattacharya SN, Singh N. Pearly penile papules: A review. Int J Dermatol 2004;43:199-201.
10Sanchez NP, Wick MR, Perry HO. Adenoma sebaceum of Pringle: A clinicopathologic review, with a discussion of related pathologic entities. J Cutan Pathol 1981;8:395-403.
11Porter WM, Bunker CB. Treatment of pearly penile papules with cryotherapy. Br J Dermatol 2000;142:847-8.
12Sapra P, Sapra S, Singh A. Pearly penile papules: Effective therapy with pulsed dye laser. JAMA Dermatol 2013;149:748-50.