Pearly papules: what should we know?

Pearly papule: what is it?

Found in 14% to 48% of men, pearly penile papules are small pink or white lesions, presenting in the form of dome-shaped or thread-like formations, one to two millimetres in diameter and one to four millimetres in height, arranged around the corona of the penis glans, usually in one or two rows. They are often more prominent along the dorsal side of the corona and can completely encircle the glans, although this is not always the case.

Rare in children, pearly papules generally develop during adolescence. Their frequency tends to decrease in older individuals, suggesting that these bumps regress with age. Contrary to what is sometimes suggested, pearly papules are benign and are not related to a lack of hygiene. Furthermore, they are not contagious.

Pearly penile papules are not indicative of a disease but simply reflect a normal aspect of the glans in some men.

How are pearly papules formed?

Pearly papules are simply due to the hypergrowth of the pilosebaceous follicles under the influence of a high level of sex hormones during puberty, primarily androgens. These stimulate the activity of the sebaceous glands and activate the proliferation of keratinocytes, the cells responsible for the formation of keratin. This increase in keratin and sebum leads to an enlargement of the pilosebaceous follicles, promoting the appearance of small outgrowths, visible in the form of pearly papules.

Histological studies conducted on pearly papules also reveal that these lesions are structurally linked to angiofibromas, such as fibrous papules, benign tumours of the fibrous tissues in which numerous small and large, often dilated, vascular channels are found. It has also been observed that pearly papules frequently coincide with an increase in the size and number of epidermal melanocytes, although this is not fully explained.

Note : Although this term more commonly refers to the small papules found on the glans, the term 'pearly papules' is sometimes used to describe similar growths observed on the vulva.

A potential treatment for pearly penile papules?

Completely harmless, the pearly penile papules require no medical intervention. However, for aesthetic reasons, some men wish to remove them, which is possible through several procedures:

Cryotherapy for treating pearly penile papules.
Liquid nitrogen cryotherapy induces a tissue necrosis of the epidermis while preserving the warmer vascularised dermis, theoretically allowing for the elimination of pearly papules. It should be noted that this technique can be painful when performed on the glans and may result in oedema, redness, or even pigment disorders. Studies evaluating the effectiveness of cryotherapy for treating pearly papules are scarce and contradictory: some have highlighted the relevance of this method in cases of pearly papules, while others have shown no effect. Further research is still necessary.
Electrodessication as a solution for overcoming pearly papules.
Electrodessication is a destructive technique that involves the use of an electrosurgical device to cauterise the cells of target lesions. Scientific literature reports two individuals with pearly papules on which electrocoagulation was performed. This procedure allowed for the complete removal of the lesions. However, these results are somewhat limited, given the small number of cases. Furthermore, caution is advised regarding electrodessication, as this technique carries a high risk of scarring.
The CO2 laser for eliminating pearly papules.
Frequently used in dermatology, the CO2 laser can be utilised to treat pearly papules. It emits at a wavelength of 10.6 µm, enabling it to target the water in tissues and vaporise it, which results in the destruction of damaged tissues. The CO2 laser is generally well-tolerated and requires a short healing time. Several studies report good results obtained after treating pearly papules with a CO2 laser.
The Erbium:YAG ablative laser: a solution to pearly papules.
The Er:YAG laser, emitting at 2940 nm, is another ablative laser used to remove pearly papules. It is highly absorbed by the water in the tissues and effectively remodels collagen. A case series involving 45 patients described the use of the Er:YAG laser and showed that on average, two sessions were sufficient to completely treat the pearly papules. As for adverse effects, only a slight erythema was observed, but the laser was found to be generally painless.
The Holmium:YAG laser, a potential treatment for pearly penile papules.
The Ho:YAG laser, emitting at 2100 nm, operates and possesses characteristics similar to the Er:YAG laser, but it has a deeper penetration of 200 to 400 μm. It is generally attributed with greater precision. However, the use of this type of laser is not recommended for individuals with dark skin as it poses a relatively significant risk of hyperpigmentation in these patients.
The pulsed dye laser (PDL) for targeting pearly papules.
Pearly papules, being partly characterised by a dense layer of collagen beneath the epidermis, can be targeted using a pulsed dye laser. A four-case report attests to its safety and effectiveness in scientific literature. Only one patient reported slight discomfort, which dissipated within the week following treatment. Occasionally, PDL may cause scarring but this is very rare.