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Cutaneous Penile Lesions

by Patrick J. Shenot, MD

Common skin disorders and infections can cause cutaneous penile lesions (see Table: Causes of Cutaneous Penile Lesions).

Causes of Cutaneous Penile Lesions

Category

Cause

Common skin disorders

Allergic or irritant contact dermatitis

Balanitis xerotica obliterans

Carcinoma in situ: Erythroplasia of Queyrat, Bowen disease

Fixed drug eruptions

Papulosquamous or systemic disorders

Psoriasis

Squamous cell carcinoma

Sexually transmitted diseases*

Chancroid

Genital herpes

Genital warts (condylomata acuminata)

Granuloma inguinale

Syphilis

Rare infectious causes

Fungal infections

Herpes zoster

Lymphogranuloma venereum

TB

Balanitis xerotica obliterans

This lesion, another name for lichen sclerosus et atrophicus in men, is an indurated, blanched area near the tip of the glans surrounding and often constricting the meatus. It results from chronic inflammation and may lead to phimosis, paraphimosis, or urethral stricture. Topical drugs, including corticosteroids, tacrolimus, antibiotics, and anti-inflammatory drugs, may be used, but their efficacy is limited. Surgery is required in severe cases.

Carcinoma in situ

Carcinoma in situ can include

  • Erythroplasia of Queyrat

  • Bowen disease of the penis

  • Paget disease of the nipple

  • Bowenoid papulosis

Erythroplasia of Queyrat and Bowen disease of the penis are well-circumscribed areas of reddish, velvety pigmentation in the genital area, usually on the glans or at the corona, primarily in uncircumcised men.

Paget disease of the nipple (not to be confused with Paget disease of bone) is a rare intraepithelial adenocarcinoma that can occur in extramammary locations, including the penis.

Bowenoid papulosis involves smaller, often multiple papules on the shaft of the penis.

These conditions are considered intraepithelial neoplasia or carcinoma in situ and should be biopsied.

Treatment consists of 5% fluorouracil cream, local excision, or laser therapy. Close follow-up is indicated.

Penile lichen planus

This lesion occurs as small papules or macules, sometimes annular, on the glans or shaft and may be mistaken for pemphigoid or erythema multiforme. Pruritus is common.

Penogingival syndrome in men (and vulvovaginal gingival syndrome in women) is a more severe form of erosive lichen planus. It occurs on both oral and genital mucosa. Ulcers may develop and cause pain.

Lichen planus usually resolves spontaneously. If asymptomatic, it may not require treatment. Topical corticosteroids may help relieve symptoms.

Pearly penile papules

These papules are small, harmless angiofibromas that appear on the corona of the penis as dome-shaped or hairlike projections and tend to be skin-colored. They may also appear on the distal shaft. They are common, occurring in up to 10% of men. They are not associated with human papillomavirus, although they may be mistaken for genital warts. Treatment is not required.

Contact dermatitis of the penis

Contact dermatitis of the penis has become more common with the widespread use of latex condoms. Dermatitis appears as red, pruritic lesions, sometimes with weeping or fissures. Treatment is with topical corticosteroids and use of nonlatex condoms (but not natural condoms, which do not provide adequate protection against HIV). Mild OTC corticosteroids can be tried first, with use of middle or high potency prescription preparations as needed.

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