Reports suggesting an increased incidence in African American males may reflect an increase in uncircumcised men in that population. Most patients with pearly penile papules seek dermatologic consultation because they are concerned about a sexually transmitted disease. Uncommonly, lesions may extend onto the glans penis. Histopathologic analysis of lesions demonstrates a variable number of thin-walled ectatic vessels in the dermis in association with a fibroblastic proliferation. Lesional fibroblasts may appear stellate or multinucleated.
Concentric fibrosis surrounding adnexal structures is an additional characteristic.
These features indicate angiofibroma and are not specific for pearly penile papules. Lesions typically are asymptomatic and require no therapy. Ablation using carbon dioxide laser, electrodesiccation with curettage, and excisional surgery reportedly have successfully eliminated lesions. Mixed results have been noted with cryotherapy. Topical application of podophyllin largely has been ineffective.