Pearly Penile Papules (PPP's)

Pearly penile papules (PPP’s) are small raised nodules usually 1-2 mm in size located circumferentially on the coronal sulcus of the glans penis. They can be white or flesh-coloured, dome-shaped or finger-like. A normal anatomical variant which usually appear during adolescence, they have been reported in up to 35% of males. Most commonly they are confused with genital warts, but there is no known link to human papilloma virus. Penile papules appear to be without functional significance – they are NOT spread through sexual activity and they have NO malignant potential. Most men with PPP’s do not seek treatment. Some, however, feel that the papules are unattractive or that they give the impression that they have warts.

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Several treatment methods have been used, including circumcision, podophyllin, electrodessication and curettage, cryotherapy, and even the amateur application of toothpaste. The carbon dioxide laser is the most effective. The laser has a long and safe history as a skin laser and is very useful in ablating both superficial and deeper lesions.

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The number of papules involved is usually quite considerable and although it cannot be guaranteed, every effort is made to remove each one in one surgical sitting, leaving the area smooth. Papules are often arranged three abreast, and up to 150 individual lesions might need ablation.  Treatment of PPP’s is undertaken at the Bishops Wood Hospital, Northwood and The Wellington Hospital, London.

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A general anaesthetic is sometimes preferred, but the operation is possible under local anaesthesia. In every case a local anaesthetic procedure is cheaper than a general anaesthetic one, and an out-patient procedure (walk-in, walk-out WIWO) is cheaper than a day case stay. You would need to stay in hospital as a day case (DC) if you chose to have a general anaesthetic, but it would be unusual to require a night’s stay in hospital. You do not need to stay in hospital after a local anaesthetic. Below the age of 16, parental or guardian consent is required.

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The recovery period is 7-10 days. For those who are uncircumcised, the foreskin acts as a dressing. A dressing is required in circumcised patients. There should be no scarring or patches left afterwards and no loss of sensitivity. The treatment permanently removes the papules. There are occasional reports in the literature of the growth of further papules many years later. 

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