Indian Journal of Dermatology
: 2014  |  Volume : 59  |  Issue : 4  |  Page : 424-

Eruptive angiokeratomas on the glans penis

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

Correspondence Address:
Mohammad Abid Keen
Department of Dermatology, STD and Leprosy, Government Medical College and Associated SMHS Hospital, Srinagar, Kashmir (J & K)

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

How to cite this URL:
Keen MA, Hassan I. Eruptive angiokeratomas on the glans penis. Indian J Dermatol [serial online] 2014 [cited 2023 Apr 1 ];59:424-424
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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}{Figure 2}

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:

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]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]Angiokeratoma circumscriptum, first reported by Fabry in 1915, usually presenting as papules with a tendency to confluence into plaques [4]Solitary or multiple (papular) types, usually involving lower extremitiesAngiokeratoma 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]


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