Pearly papule: what is the treatment?

The Er:YAG laser, emitting a wavelength of 2940 nm, is an ablative device particularly suited for treating pearly papules due to its strong affinity for water found in skin tissues. When it penetrates the skin, this laser induces a rapid vaporisation of the epidermal cells, allowing for precise ablation of the papules, without damaging the adjacent tissues. This process of micro-ablation not only reduces the visibility of the papules but also stimulates a remodelling of the underlying collagen fibres. By activating the fibroblasts, it supports the production of new collagen fibres, contributing to a smoother skin texture.

A case series involving 45 patients described the use of the Er:YAG laser and demonstrated that, on average, two sessions were sufficient to completely treat pearly papules. In terms of adverse effects, only a slight erythema was observed, but the laser treatment was generally painless. A follow-up was conducted one year after the procedure and showed no recurrence of the pearly papules.

The Ho:YAG laser, with a wavelength of 2100 nm, operates similarly to the Er:YAG laser but possesses a greater precision, derived from its ability to penetrate more deeply into tissues, approximately 200 to 400 μm. However, this laser is less suitable for darker skin as it carries a higher risk of causing hyperpigmentation. Indeed, the melanocytes of individuals with darker skin, which produce more melanin, are more sensitive to the thermal changes induced by this type of laser.

A study was conducted on three patients with fair skin who presented with pearly papules. Following a Ho:YAG laser session, all participants were found to be satisfied and no side effects were observed. Furthermore, no recurrence of the pearly papules was noted in the sixteen months following the procedure. However, the results of this study should be interpreted with caution due to the small number of participants.

Pearly papules, often featuring a dense layer of collagen beneath the epidermis, can be effectively targeted by a pulsed dye laser. This type of laser, which utilises a specific wavelength absorbed by vascular structures and collagen, is designed to induce controlled heating of the target area, allowing for coagulation that gradually reduces the volume of the papules. Although generally not very painful, the pulsed dye laser can sometimes result in temporary redness and mild swelling.

A report of four cases highlights its safety and effectiveness in the scientific literature. Following a session of pulsed dye laser, all individuals reported satisfaction with the treatment and saw their pearly papules disappear. Only one patient reported slight discomfort which dissipated within the week following the treatment. However, given the relatively small sample size, caution is advised regarding the results obtained.

It is also possible to utilise electrodessication to eliminate pearly papules. This technique employs a high-frequency electric current. This current, applied via a thin electrode, generates heat which leads to the controlled destruction of tissues. This process is often appreciated for its precision, allowing only the papules to be treated without affecting the surrounding skin areas. Electrodessication is generally quick and well-tolerated, although it may temporarily cause redness and temporary scabs.

Only two cases of patients with pearly papules treated by electrodessication are reported in the scientific literature. After one session, the individuals noticed a complete disappearance of their pearly papules. However, the small number of patients calls for caution: further work on the value of electrodessication for treating pearly papules is still necessary to confirm the relevance of this technique.

Cryotherapy, which involves the application of liquid nitrogen at extremely low temperatures, causes a controlled destruction of superficial tissues through rapid freezing. This process induces necrosis of the epidermis through the formation of intracellular ice crystals, leading to the rupture of membranes and the cessation of cellular functions. During this treatment, the vascularised dermis is preserved due to its slightly higher temperature, allowing for faster regeneration and minimising the risks of deep scarring.

In theory, this technique is suitable for eliminating pearly papules, although it is applied with caution due to the increased sensitivity of the glans, where it can cause pain and various side effects, such as oedema, redness or post-inflammatory pigmentation disorders. Few scientific studies have been conducted on the relevance of cryotherapy in the case of pearly papules. The results of three of these are compiled in the table below.