Hirsuties Coronae Glandis General Information
Pearly penile papules, otherwise known as hirsuties coronae glandis, are dome-shaped, skin-colored papules (“bumps”) that are found at the ridge of the corona of the glans penis.
Their sizes range from less than 1mm to 3mm. They are commonly arranged around the circumference of the crown of the glans penis, in one or several rows. Often they are wrongly assumed to be sexually transmitted because of their appearance and location.
Pearly penile papules are considered to be of normal variant, not known to cause any type of cancers, and are definitely not sexually transmitted. However, the condition causes anxiety to most patients, until their non-cancerous nature is clarified.
Pearly penile papules are commonly observed in men in their second or third decades of life, with a noted decrease in frequency with aging. They are, however, more often observed in uncircumcised men. Interestingly, in uncircumcised males with pearly penile papules who undergo circumcision, regression of papules is also commonly observed. The mechanism underlying their development remains to be unknown.
Most patients with pearly penile papules seek dermatologic consultation because they are concerned about a sexually transmitted disease. Pearly penile papules most commonly are confused with sexually-transmitted infections, such as genital warts (condyloma acuminatum) or with molluscum contagiosum, as all three have fleshy, dome-shaped appearances, with the latter two most noted during the early stages of the illness.
On physical examination, pearly penile papules appear as one or several rows of small, flesh-colored, smooth, dome-shaped papules arranged circumferentially around the crown of the glans penis. Although not usually noted, they sometimes extend onto the glans penis in some patients. Pearly penile papules are typically not accompanied with other signs or symptoms, unlike sexually-transmitted genital warts. They persist throughout life, however, they may gradually become less noticeable with older age.
Some clinical studies show that pearly penile papules occur more commonly in uncircumcised men, compared to their circumcised counterparts. In the past, pearly penile papules were believed to be caused by accumulated smegma in uncircumcised men. However, present data show that this is untrue.
Currently, there are no indications for laboratory and imaging studies recommended in diagnosing pearly penile papules.
Confirmation of a diagnosis of pearly penile papules may be obtained by taking a biopsy specimen of the lesion for histologic and pathologic analysis. Likewise, given their non-cancerous nature, no staging system exists, nor it is necessary.
Since pearly penile papules do not have any other associated signs and symptoms, and do not pose any life-threatening conditions, they do not require any oral antibiotic, antiviral, or anti-parasitic therapy or medication. There are also no known topical medication that can treat pearly penile papules.
However, the appearance of pearly penile papules can cause great anxiety to most patients and their sexual partners, finding them aesthetically displeasing. Thus patients request for treatment for possible surgical procedures for them to be removed.
Among the surgical treatments available for the removal of pearly penile papules include ablation using carbon dioxide laser, electrodessication with curettage, and excisional surgery. The surgical procedures are defined as follows:
- A carbon dioxide laser is a type of laser used in cosmetic procedures, and is also the first laser to be used as a surgical tool. It is an ablative laser, which means it vaporizes the skin on the surface, removing the topmost layers of the skin. This procedure is effective in addressing many skin problems and results in eventual skin tightening.
- Electrodessication and curettage is a procedure commonly performed by dermatologists and surgeons for the treatment of certain skin cancers, such as basal cell cancers and squamous cell skin cancers. The procedure involves a round, dull instrument, called a curette, which is used to scrape off the lesion down to the deeper layers of the skin. Electrodessication is then performed, by using an electrical spark to burn and destroy the affected skin tissues. A cycle of curettage and electrodessication is done, until the surgeon is satisfied with the depth of destruction of the affected skin area, in this case, the crown of the glans penis.
- Excisional surgery is a procedure used by removing a mass or a tumor using a scalpel. However, in treating pearly penile papules, this can be tiresome and might take a longer while to finish.
It should be noted that the cause of pearly penile papules is poorly understood. Likewise, diet, personal hygiene, and sexual activity are not known to cause pearly penile papules.
Further care and outcome
For most patients, they generally accept that treatment is not necessary for pearly penile papules once the benign nature of the condition is explained. Patients who insist on treatment may opt to undergo the aforementioned surgical procedures.
The incidence of pearly penile papules may be decreased with circumcision, since the frequency of lesions is fewer among circumcised males versus uncircumcised ones.
There are no known or observed complications of pearly penile papules, mild or otherwise.
It is very important to educate patients about pearly penile papules for reassurance of its benign nature. Patients should be informed that these are not transmitted sexually. Counseling of both the patient and his sexual partner may alleviate the anxiety of both parties.
Alternative Remedies and Home Removal
Pearly penile papules as mentioned above is best treated with surgery, but I know it’s not always an option, specially for men since its hard for guys to think of a surgery down there. If you are not into surgery then a good old home remedies might do the trick for you, although be advised that it is not guaranteed. A good example is the use of castor oil, the united states food and drug administration considered this as “generally safe and effective”. Another method is the use of hydroxy acid to inhibit the abnormal cells from going. Home remedies for Pearly Penile papules are very hard to find since then again, this condition is not caused by bacteria or viruses and is not related to any STDs. But the home remedies that were mentioned offers a great alternative source for treating these little monsters.