Q: What are the pros and cons of pearly penile papules treatment?

Pros Treatments are fast (20–30 minutes) and painless, thanks to a topical anesthetic. Healing takes about a week, but you’re usually able to resume most activities (aside from sexual activity) right away. Penile skin usually heals without scars or a reduction in sensation. Though PPP are harmless and don’t require treatment, removal of the lesions can reduce embarrassment and boost confidence. Treatment can be done safely on any skin type and tone. The cost may be covered by health insurance. Cons Some treatment options require two or more sessions to fully remove PPPs. About 20% of the time, treated lesions recur and require additional treatment. In that case, waiting about three months between treatment sessions is recommended. New lesions can still develop. In the hands of an inexperienced provider, a laser treatment can cause changes in pigmentation or leave scars. Home remedies for PPP don’t work and can result in serious side effects, including scarring. “People shouldn’t muck around with their faces or their privates, two sources of great regret if scarring occurs,” says Dr. Barankin. Rarely, temporary loss of sensation can occur, and it can take up to a full year for the sensation to return. If there’s still decreased sensation after a year, a P-Shot , an injection of platelet-rich plasma into the corona, can help return sensation , says Dr. Robert Cohen , a physician in Los Angeles.

Question 1

What are pearly penile papules?

Accepted Answer

Pearly penile papules (PPP) are small, benign, pink or white dome-shaped growths that form around the rim of the head of the penis (aka the corona of the glans penis). Also known as hirsutoid papillomas, they can occur in one to two rows.

PPPs are a very common skin condition—up to 43% of men have them. They’re more common in uncircumcised men and typically appear in the teens to the early 20s, says Dr. William Groff, a dermatologist and dermatologic surgeon in San Diego who has treated more than 2,000 cases of PPP.

The cause of PPP is unknown. While there isn't definitive evidence that they can go away on their own, a study published in the American Journal of Men's Health in 2016 says that "The prevalence declines in older patients, suggesting that the lesions regress with age."

The bumps are harmless, painless, and don't itch. They can look like the genital warts caused by the human papillomavirus (HPV), and they may be mistaken for a sexually transmitted disease. However, they’re not contagious and can’t be transferred to a partner. If your papules that are itchy, see your primary healthcare provider first to make sure you're not dealing with a sexually transmitted infection (STI).

Treatment of pearly penile papules isn't required, due to their benign nature. But many men—and sometimes their partners—find the lesions unsightly and want them removed.

“They’re a cosmetic issue that’s a nuisance for men,” who often become self-conscious about them, says Dr. Benjamin Baranken, a dermatologic surgeon in Toronto.

Question 2

What are the pros and cons of pearly penile papules treatment?

Accepted Answer

Pros

Treatments are fast (20–30 minutes) and painless, thanks to a topical anesthetic.
Healing takes about a week, but you’re usually able to resume most activities (aside from sexual activity) right away.
Penile skin usually heals without scars or a reduction in sensation.
Though PPP are harmless and don’t require treatment, removal of the lesions can reduce embarrassment and boost confidence.
Treatment can be done safely on any skin type and tone.
The cost may be covered by health insurance.

Cons

Some treatment options require two or more sessions to fully remove PPPs.
About 20% of the time, treated lesions recur and require additional treatment. In that case, waiting about three months between treatment sessions is recommended.
New lesions can still develop.
In the hands of an inexperienced provider, a laser treatment can cause changes in pigmentation or leave scars.
Home remedies for PPP don’t work and can result in serious side effects, including scarring. “People shouldn’t muck around with their faces or their privates, two sources of great regret if scarring occurs,” says Dr. Barankin.
Rarely, temporary loss of sensation can occur, and it can take up to a full year for the sensation to return. If there’s still decreased sensation after a year, a P-Shot, an injection of platelet-rich plasma into the corona, can help return sensation, says Dr. Robert Cohen, a physician in Los Angeles.

Question 3

How do you get rid of penile papules?

Accepted Answer

There are various ways to treat PPP: fractional resurfacing laser treatments, electrotherapy, cryotherapy (using intense cold to freeze off the lesions, with a success rate of up to 90%), and chemical agents.

Surgical removal with a scalpel is also possible, but this option is the most likely to leave scars.

The gold-standard treatment option, according to Dr. Groff, is laser therapy using a fractionated CO2 laser (sometimes called a carbon dioxide laser) like the DeepFX. This allows the provider to vaporize each papule individually, without damaging surrounding tissue.

A 2015 article in the Journal of Clinical and Aesthetic Dermatology backs up his assertion, with several case reports of successful penile papule treatments with a CO2 laser.

“The beauty of the CO2 laser, when used properly, is that it’s safe, is effective, and requires only one treatment,” says Dr. Groff. Because it removes only a fraction of the skin's surface, healing takes about five days.

Other laser surgery options include the pulsed-dye laser, which requires two to three treatment sessions, and the ablative Erbium: yttrium-aluminium-garnet (Er:YAG) laser, which can take up to five treatment sessions. Pulsed-dye lasers don't remove the top layer of skin; the Er:YAG does, so it can take a few days longer to heal.

Whatever treatment is used, a strong topical anesthetic cream will be applied for up to an hour beforehand (no needles involve), so the procedure is virtually painless.

Question 4

Do home treatments for pearly penile papules work?

Accepted Answer

When it comes to self-treatment, Dr. Groff says that in his experience there’s no home treatment that can get rid of PPP. “Some may be harmless, but many have potential harm,” he warns. “Those sold on the internet can be extremely dangerous and can lead to genital disfigurement and impaired sexual function.”

Topical treatments deemed ineffective by doctors on RealSelf include glycolic acid and Retin-A. “Neither will remove pearly penile papules,” says Dr. Jeff Rapaport, a dermatologic surgeon in Englewood Cliffs, New Jersey. “They may appear slightly improved—however, they will not disappear.” The topicals are also likely to cause redness, peeling, and irritation. According to Dr. Groff, 3P Gel, which is a combination of retinol (a cousin of Retin-A) and hydroxy acids, isn’t effective either.

Question 5

How long does recovery take?

Accepted Answer

Healing time is usually five to seven days, depending on the type of treatment you have. You won't need any downtime away from work post-treatment, but you will need to avoid sexual activity for two weeks while you heal.

Your provider will prescribe an antibiotic cream and recommend that you apply that, along with a thick ointment like Vaseline, twice a day for a week.

Tiny scabs may develop that will take a few days to come off in the shower. Don’t pick at them; that can lead to infection and scarring.

Question 6

Do home treatments for pearly penile papules work?

Accepted Answer

When it comes to self-treatment, Dr. Groff says that in his experience there’s no over-the-counter home treatment to get rid of PPP. “Some may be harmless, but many have potential harm,” he warns. “Those sold on the internet can be extremely dangerous and can lead to genital disfigurement and impaired sexual function.”

Topical treatments deemed ineffective by doctors on RealSelf include wart removers, glycolic acid, and Retin-A. “Neither will remove pearly penile papules,” says Dr. Jeff Rapaport, a dermatologic surgeon in Englewood Cliffs, New Jersey. “They may appear slightly improved—however, they will not disappear.”

These topicals (or home remedies like lemon juice) are also likely to cause redness, peeling, and irritation. According to Dr. Groff, 3P Gel, a combination of retinol (a cousin of Retin-A) and hydroxy acids, isn’t effective either.

PEARLY PENILE PAPULES TREATMENT

Karyn Repinski

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Karyn Repinski

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