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  • Anogenital skin and mucosa are subject to unique disorders because of their special anatomy.
  • Dermatologic and systemic disorders occur in the anogenital region.
  • Primary neoplasms arise in these areas, most commonly associated with chronic human papillomavirus (HPV) infection.
  • Sexually transmitted as well as other infections also occur commonly in these sites.

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These normal structures, newly observed, give rise to great concerns about sexual transmitted infections such as anogenital warts and molluscum contagiosum.

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Pearly Penile Papules

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  • Normal anatomic structures. Incidence: Up to 19%.
  • Symptoms: Asymptomatic; may arouse some anxiety when first noted.
  • Clinical findings: Skin-colored 1- to 2-mm, discrete, domed papules evenly distributed circumferentially around the corona (Fig. 35-1), giving a cobblestone pattern.
  • Differential diagnosis: Condylomata acuminatum, molluscum contagiosum
  • Histology: Angiofibromas.
  • Management: Reassurance: normal anatomic structures.

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Synonym: Angiofibromas

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Figure 35-1
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Pearly penile papules Pink (skin-colored), 1- to 2-mm papules are seen regularly spaced along the corona of the glans penis. These structures, which are part of the normal anatomy of the glans, are commonly mistaken for condylomata or molluscum contagiosum.

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Sebaceous Gland Prominence

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  • Normal sebaceous glands. Analogous to sebaceous gland on mucosa of mouth.
  • Locations: Penis, vulva.
  • Manifestation: 2-mm dermal papule; cream colored. May be arranged in rows.

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Synonyms: Tyson glands, sebaceous hyperplasia, “ectopic” sebaceous glands, Fordyce condition

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Angiokeratoma

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  • Ectatic thin-walled blood vessels in the superficial dermis with overlying epidermal hyperplasia.
  • Increasingly common with aging.
  • Multiple purple, smooth, 2- to 5-mm papules. Bleed with trauma. (See Section 9, Fig. 9-27).
  • Location: Scrotum, glans penis, penile shaft. Labia, vulva
  • Differentiate from angiokeratomas of Fabry disease (usually pinhead size, found on bathing trunk area and upper thighs), Kaposi sarcoma.
  • Management: Reassurance. electrosurgery

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Synonym: Angiokeratomas of Fordyce

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Chronic Pain Syndrome

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  • Pathogenesis: Unknown.
  • Symptoms: Itching, burning, redness, pain on vulva, penis/scrotum, or perineum.
  • Manifestations: Absence of mucocutaneous findings.
  • Differentiate from dysmorphophobia, depression, psychosis.

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Synonyms: Penodynia, scrotodynia, red or burning scrotum syndrome, vulvodynia, perineal pain.

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Sclerosing Lymphangitis of Penis

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  • Etiology: Trauma associated with vigorous sexual activity.
  • Pathogenesis: Lymphatic stasis may result in thrombosed lymphatic vessels. Subsequent recanalization and fibrosis of walls of lymphatic vessels.
  • Clinical findings: Painless, firm, at times nodular, translucent serpiginous cord appears suddenly, usually parallel to corona; not attached to overlying epidermis (Fig. 35-2).
  • Course: Resolves spontaneously in weeks to months.

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Synonyms: Nonvenereal sclerosing lymphangitis, penile venereal edema, Mondor phlebitis

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Figure 35-2
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