Everything you need to know about pearly penile papules.

Pearly papules are simply due to the hypergrowth of hair and sebaceous follicles under the influence of a high level of sex hormones during puberty, primarily androgens. These hormones 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 hair and sebaceous 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 related to angiofibromas, such as fibrous papules, benign tumors of 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 frequently refers to the small papules found on the glans, the term "pearly papules" is sometimes used to describe similar growths observed on the vulva.

Completely harmless, the pearly penile papules do not require any 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 vascularized 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 cause edema, 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. More research is still needed.

• Electrodessication as a solution for overcoming pearly papules.

  Electrodessication is a destructive technique that involves the use of an electrosurgical device to cauterize 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 quite 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 utilized to treat pearly papules. It emits at a wavelength of 10.6 µm, allowing it to target the water in tissues and vaporize 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 an average of two sessions was sufficient to completely treat the pearly papules. As for adverse effects, only mild erythema was observed, but the laser was found to be generally painless.

• The Holmium:YAG laser, a possible 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 characterized by a dense layer of collagen under the epidermis, can be targeted with a pulsed dye laser. A four-case report attests to its safety and effectiveness in scientific literature. Only one patient reported slight discomfort that dissipated within the week following treatment. Occasionally, the PDL may cause scarring but this is very rare.