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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Many treatment methods are offered for PPP removal, including circumcision, podophyllin, electrodessication and curettage, cryotherapy, and even the  application of a variety of acids, ointments, and potions. Both use and misuse of these methods can cause scarring. Unfortunately, a number of myths have made their way onto some normally quite accurate and sensible websites.  It is not the case that pulsed dye lasers are more likely to be effective, for example,, nor is it the case that the pulsed dye laser would be more expensive. David Gault recommends only the carbon dioxide laser as the most effective means of removal of pearly penile papules, The laser has a long and safe history as a skin laser and is very useful in ablating both superficial and deeper lesions.

Fordyce spots, collections of sebaceous glands with keratin plugs, are often to be found on the skin of the shaft of the penis.  Again, these are quite normal, but again cause concern because of their appearance.  Formal excision of the individual lesions usually gives the best results.

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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 carried out at The Wellington Hospital, London for best results.

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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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