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    Atypical Pearly Penile Papules Mimicking Primary Syphilis

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    mamal malika
    This letter describes an atypical presentation of pearly penile papules (PPP) that was initially misdiagnosed as primary syphilis. A 41-year-old man presented with two smooth, annular papules on the dorsal penis near the neck, an uncommon location for PPP. Histological examination found features of angiofibroma, confirming the diagnosis of PPP. Though PPP usually appear on the coronal rim, this case highlights that they can occasionally present atypically, so biopsy may be needed when the diagnosis is uncertain to avoid misdiagnosis and unnecessary treatment.

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    Atypical Pearly Penile Papules Mimicking Primary Syphilis

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    mamal malika
    200 views2 pages
    This letter describes an atypical presentation of pearly penile papules (PPP) that was initially misdiagnosed as primary syphilis. A 41-year-old man presented with two smooth, annular papules on the dorsal penis near the neck, an uncommon location for PPP. Histological examination found features of angiofibroma, confirming the diagnosis of PPP. Though PPP usually appear on the coronal rim, this case highlights that they can occasionally present atypically, so biopsy may be needed when the diagnosis is uncertain to avoid misdiagnosis and unnecessary treatment.

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    16_Gouvela

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    This letter describes an atypical presentation of pearly penile papules (PPP) that was initially misdiagnosed as primary syphilis. A 41-year-old man presented with two smooth, annular papules on the dorsal penis near the neck, an uncommon location for PPP. Histological examination found features of angiofibroma, confirming the diagnosis of PPP. Though PPP usually appear on the coronal rim, this case highlights that they can occasionally present atypically, so biopsy may be needed when the diagnosis is uncertain to avoid misdiagnosis and unnecessary treatment.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    200 views2 pages

    Atypical Pearly Penile Papules Mimicking Primary Syphilis

    Uploaded by

    mamal malika
    This letter describes an atypical presentation of pearly penile papules (PPP) that was initially misdiagnosed as primary syphilis. A 41-year-old man presented with two smooth, annular papules on the dorsal penis near the neck, an uncommon location for PPP. Histological examination found features of angiofibroma, confirming the diagnosis of PPP. Though PPP usually appear on the coronal rim, this case highlights that they can occasionally present atypically, so biopsy may be needed when the diagnosis is uncertain to avoid misdiagnosis and unnecessary treatment.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 2

    Acta Dermatovenerol Croat

    2014;22(4):311-312 LETTER TO THE EDITOR

    Atypical Pearly Penile Papules Mimicking Primary


    Syphilis
    Pearly penile papules (PPP) are benign and com- Several modes of therapy are used for treating
    mon lesions in the male population. Several terms PPP, including cryotherapy, electrodesiccation, podo-
    have been used to describe this entity, including phyllin, curettage, and carbon dioxide laser ablation;
    Tyson glands, hirsutoid papillomas, papilla in the co- however, treatment should be reserved for patients
    rona glandis, hirsutis papillary corona of the penis, who have cosmetic or psychological concerns from
    corona capilliti, and pink pearly papules (1,2). PPP the appearance of this benign entity (2).
    commonly develop after puberty and their incidence We report on the case of a 41-year-old Caucasian
    decreases with age (1). The prevalence of this condi- man with a history of several months of two non-
    tion is estimated to be 14%-48%, the incidence be- painful, smooth papules with a central depression,
    ing higher among black males and uncircumcised elevated borders, and annular shape on the dorsal
    men (1,3). Their histologic features are characteristic surface of the penis near the neck (Fig. 1). Physical ex-
    of angiofibroma and are typically localized to the co- amination of the genitalia was otherwise unremark-
    rona and the sulcus of the penis but can also affect able. Before his referral, the lesions had been misdiag-
    the shaft (1). PPP may resemble other entities such as nosed as primary syphilis and treated with penicillin
    condylomata acuminata, ectopic sebaceous glands, without response.
    molluscum contagiosum and lichen nitidus, leading
    Because of the uncommon presentation and the
    to hazardous and unwarranted treatments (1,2).
    patient´s fear of having a sexually transmitted dis-
    Pearly penile papules are commonly seen in clin- ease, a skin biopsy was performed. Histologic exami-
    ics for sexually transmitted disease (STD) and are a nation revealed dermal ectatic venules embedded in
    cause of anxiety in adolescence and young manhood a collagenous stroma with several stellate fibroblasts,
    (4). In some studies about PPP, human papillomavirus recovered by a dome shaped acanthotic epidermis
    (HPV) was suggested to play a role (5), however, Ho- (Fig. 2). These findings matched the histologic fea-
    gewoning et al. showed that there is no association tures of angiofibroma, and the diagnosis of PPP was
    between PPP and HPV (3). established. The benign nature of these lesions was

    Figure 1. Pearly penile papules. Clinical features: two Figure 2. Pearly penile papules. Histologic features of
    smooth annular shaped papules. an angiofibroma (hematoxylin and eosin ×40).

    ACTA DERMATOVENEROLOGICA CROATICA 311


    Letter to the editor Acta Dermatovenerol Croat
    2014;22(4):311-312

    explained to the patient and therefore no treatment 7. Vesper JL, Messina J, Glass LF, Fenske NA. Profound
    was necessary. proliferating pearly penile papules. Int J Dermatol
    PPP may vary in shape, size, and color (1), usu- 1995;34:425-6.
    ally range from 1 to 2 mm in width and 1 to 4 mm 8. O’Neil CA, Hansen RC. Pearly penile papules on
    in length, and can be acuminate, dome, or annular the shaft. Arch Dermatol 1995;131:491-2.
    shaped (6). Their color may be pink, white, yellow- 9. Dourmishev LA, Dourmishev AL. Syphilis: un-
    ish, or rarely almost translucent, and they are com- common presentations in adults. Clin Dermatol
    monly oriented in a single or double row on the co- 2005;23:555-64.
    rona, which may partially or completely encircle the
    10. Patel H, Wagner M, Singhal P, Kothari S. Systematic
    glans (1). There are reports of profound proliferating
    review of the incidence and prevalence of genital
    PPP arranged radially from the meatus to the corona,
    warts. BMC Infect Dis 2013;13:39.
    spreading all over the glans (7), ectopic PPP on the
    penile shaft of a young boy without typical lesions on
    the corona (6), and typical coronal lesions on the ven- Ana Isabel Gouveia1, João Borges-Costa1,2,3,
    tral aspect of the penis in an adult man (8). However, Luis Soares-Almeida1,2
    PPP localized exclusively near the neck of the penis
    with the abovementioned morphology and without
    Clínica Universitária de Dermatologia, Hospital de
    1
    typical lesions in other localizations in an adult man,
    Santa Maria; 2Instituto de Medicina Molecular, Facul-
    as in our patient, has not yet been described. This case
    dade de Medicina da Universidade de Lisboa; 3Instituto
    thus represents an atypical and rare presentation of
    de Higiene e Medicina Tropical, Lisbon, Portugal
    PPP that could be confused with primary syphilis or
    condylomata acuminata.
    The clinical manifestations of syphilis, the “great
    imitator” of skin diseases, are variable in appearance Corresponding author:
    and have been reported for centuries (9). HPV is the Ana Isabel Gouveia Clínica Universitária de
    most frequent sexually transmitted viral infection in Dermatologia Hospital de Santa Maria
    the world (10) and a common reason to seek medical Av. Professor EGas Miniz
    attention in sexually transmitted disease clinics.
    1649-035 Lisbon
    Physicians should be aware of the different clini-
    cal presentations of PPP and when the diagnosis is Portugal
    uncertain, a biopsy should be performed. anaisabelgouveia@hotmail.com

    Received: February 27, 2014


    References Accepted: October 1, 2014
    1. Agrawal SK, Bhattacharya SN, Singh N. Pearly pe-
    nile papules: a review. Int J Dermatol 2004;43:199-
    201.
    2. Körber A, Dissemond J. Pearly penile papules.
    CMAJ. 2009;181:397.
    3. Hogewoning CJ, Bleeker MC, van den Brule AJ, Vo-
    orhorst FJ, van Andel RE, Risse EK, et al. Pearly pe-
    nile papules: still no reason for uneasiness. J Am
    Acad Dermatol 2003;49:50-4.
    4. Neinstein LS, Goldenring J. Pink pearly papules:
    an epidemiologic study. J Pediatr 1984;105:594-5.
    5. Mayeaux EJ Jr, Harper MB, Barksdale W, Pope JB.
    Noncervical human papillomavirus genital infec-
    tions. Am Fam Physician 1995;52:1137-46,1149-
    50.
    6. Neri I, Bardazzi F, Raone B, Negosanti M, Patrizi A.
    Ectopic pearly penile papules: a paediatric case.
    Genitourin Med 1997;73:136.

    ACTA DERMATOVENEROLOGICA CROATICA


    312

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