Dermoscopy of pearly penile papules

A 32-year-old male presented to the dermatology OPD with chief complaints of multiple, asymptomatic papules on his glans. On examination, he was found to have multiple, pink to white, 1–2 mm in size, smooth, dome-shaped papules arranged in multiple rows along the corona of the glans penis. Dermoscopic examination revealed multiple, whitish-pink papules arranged in a cobblestone manner in multiple rows with each papule containing a central dotted or comma-shaped vessel (Heine Delta 20T dermatoscope, contact mode, non-polarized, ×10) [Figure 1].

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Figure 1:

Dermoscopic examination showing multiple whitish-pink papules arranged in multiple rows along the corona of the glans penis with a central dotted or comma-shaped vessel within each papule (Heine Delta 20T dermatoscope, contact mode, non-polarized, ×10).

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Pearly penile papules are benign lesions of the glans penis that are commonly mistaken for sexually transmitted infections. They usually present as white to pink, dome shaped, or filiform papules that orient themselves in rows around the corona of the glans penis. They need to be differentiated from Tyson’s glands, condyloma acuminata, and molluscum contagiosum. On dermoscopy, pearly penile papules appear as white to pink papules arranged in a grape like or cobblestone pattern and each papule has a central dotted or comma-shaped vessel within it. The main dermoscopic differential for pearly penile papules is viral warts, which on dermoscopy show irregular vascular system with multiple red or black dots signifying intravascular clots as well as multiple punctate dotted vessels and bigger vessels in the form of red globules. Other conditions that need to be differentiated on dermoscopy include molluscum contagiosum, ectopic sebaceous glands, and, rarely, lichen nitidus.^[1]