Penoscrotal porokeratosis: An uncommon entity

A 29-year-old gentleman presented with a four-month history of redness, mild pruritus, and discomfort over the scrotum and shaft of the penis. There was a history of application of topical steroids and antifungal combination creams, but there was no change in the lesions. Mucocutaneous examination revealed multiple well-circumscribed annular plaques characterized by a typical thready raised margin distributed over the scrotum and base of the penis extending toward the shaft [Figure 1]. There were no similar lesions elsewhere in the body. Hair, nails, and mucosae were normal. Venereal disease research laboratory test was non-reactive, and routine laboratory investigations were within normal limits. Punch biopsy followed by histopathology revealed classical cornoid lamella [Figure 2]. Based on clinicopathological correlation, a diagnosis of penoscrotal porokeratosis has been made. He has been prescribed mometasone furoate 0.1% cream.

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Figure 1:

Multiple well-circumscribed annular plaques with a thready border.

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Figure 2:

Photomicrograph showing parakeratotic column of cells overlying hypogranulosis (H&E, ×100).

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Penoscrotal porokeratosis is classically seen in young men in their third decade of life. Patients usually present with extremely itchy plaques and patches with a rough granular surface distributed over the shaft of the penis and anterior scrotum.^[1,2] Differential diagnoses of penoscrotal porokeratosis include lichen planus, psoriasis, sarcoidosis, and secondary syphilis.