Smegma pearl in a young boy

An 18-month-old boy was brought to the dermatology outpatient department by his apprehensive parents, concerned about a white nodule on his penis. The child was otherwise healthy, with no history of difficulty voiding. The mother denied any similar lesions elsewhere on the body or any history of trauma. The boy was born full-term to a primigravida mother through spontaneous vaginal delivery, with a birth weight of 3 kg. Local examination of the external genitalia revealed a soft, non-tender, round, and yellowish-white nodule measuring 0.25 × 0.25 cm over the foreskin, with a white cheesy material on its tip [Figure 1]. The parents were reassured and counseled about the benign nature of the condition.

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Figure 1:

Round, yellowish-white nodule measuring 0.25 × 0.25 cm over the foreskin with a whitish cheesy material on its tip.

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A smegma pearl, also known as a “keratin pearl,” is a nodule of trapped smegma. It is a benign accumulation of smegma in the sub-preputial space, typically observed in uncircumcised boys but also reported in circumcised males.^[1] The smegma pearl appears as a yellowish-white nodule, often located on the ventral side of the glans, between the base of the glans and the sub-preputial surface. The prepuce is partially retractable, and the urethra remains unaffected.^[2] Smegma has a characteristic slimy smell and is composed of epithelial cells, fats, and proteins. The primary treatment involves reassurance and counseling, with the expectation that the nodule will resolve spontaneously over time.^[1,2] The differential diagnosis includes preputial Epstein pearls, preputial cysts, median raphe cysts, and smegma stones (smegmaliths).^[2]