Pearly rash on penis

Genital pearly papules, also known as pearly genital papules, genital hairy papilloma, coronal sulcus or glans penis papules, are also called hairy genitals or multi-papillary genitals by scientists. At present, genital pearly papules are mostly considered to be a symptom, not a disease. This symptom is often seen in the outpatient clinic of the STD hospital and is often easily misdiagnosed as condyloma acuminatum.

1. Causes and prevalence

The cause and prevalence of male genital pearly papules are not clear. Some scholars believe that this symptom is a physiological growth and development abnormality. Some scholars believe that it is related to the length of the foreskin. For example, Hu Xiao et al. found that the prevalence of male genital pearly papules in young men with long foreskin was significantly higher than that in normal men with long foreskin. Some scholars also believe that this symptom may be related to HPV infection, but Ferenczy et al. and Shen Kaijin et al. tested HPV in the diseased tissue and found no HPV. Observation shows that the patient's long foreskin, poor local hygiene, long-term irritation of secretions and stains in the coronal sulcus, or other factors such as infection may cause local swelling and other inflammatory sensations that may be the direct cause of this symptom.

2. Clinical symptoms

Male genital pearly papules are common in men around 20-30 years old. The lesions mainly occur at the junction of the edge of the glans penis and the coronal sulcus and/or the frenulum of the penis. The lesions are 1-3mm in size and are located on both sides of the frenulum of the penis. The top of the papules is round and smooth, and some papules are hairy or flocculent. The papules are mostly combined with each other, and are often clustered and arranged in one or several rows. They are obvious between the glans penis and may partially or completely surround the glans penis. The color of the lesions is mostly pearly white, and very few are dark red or skin-colored. Some may be slightly swollen. There is no tenderness, no rupture, and the patient has no active symptoms.

3. Tissue pathophysiology examination

The histological pathophysiological examination of pearly papules on the male genitals mainly showed excessive keratinization, moderate to severe hyperplasia of the epidermis, normal dermis, slight hyperplasia and high density of fibroblasts in the dermis, varying degrees of hyperplasia and enlargement of dermal papillary capillaries, a small amount of reticulocyte infiltration around them, and no concave cells.

4. Diagnostic key points

The key point of diagnosis of male genital pearly papules and condylar warts is that the former is limited to the edge of the glans penis, with a large number of lesions, pearly milky white papules, smooth surface, and no enlargement with the increase of medical history, and the acetic acid test is negative; while the latter is not localized to the edge of the glans penis, but mostly scattered alone, with large lesions, uneven surface, and mostly cauliflower-like growths, which gradually enlarge with the increase of medical history, positive acetic acid test, and histopathological examination shows hollow cells.