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Pearly Penile Papules — SCE Dermatology MCQ

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HardGenital DermatologyPearly Penile PapulesSCE Dermatology

A 35-year-old man presents with multiple small papules on his penile shaft and inner prepuce. They are pearly white, dome-shaped, 1-2 mm, arranged in rows around the corona. They are asymptomatic and have been present for years. He is anxious about a possible STI. What is the most likely diagnosis?

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Correct answer: D — Pearly penile papules (hirsuties papillaris genitalis)

The best answer is “Pearly penile papules (hirsuties papillaris genitalis)”. Genital lichen sclerosus causes pruritic porcelain-white atrophy and architectural change; persistent focal thickening, erosion, ulceration or tenderness requires assessment for differentiated VIN or squamous carcinoma. The alternatives “Molluscum contagiosum, when the full phenotype supports it”, “Fordyce spots, within an appropriate UK pathway”, “Genital warts (condylomata acuminata)”, “Lichen nitidus, after specialist assessment” are clinically adjacent possibilities, but they do not fit the defining morphology, distribution, histopathology, risk signal or management sequence in this stem.

Reference: BAD lichen sclerosus information: https://www.bad.org.uk/pils/lichen-sclerosus-in-females