What Are Pearly Penile Papules (PPP)?

Pearly penile papules (PPP) are small, harmless, pearly white or flesh-colored bumps on the glans penis (head or tip of the penis). They are a normal skin variation. 

PPP are not the result of any sexually transmitted infection or disease (STI/STD), illness, or cancer. 

This skin variation is relatively common, occurring in about 14-48% of males. They typically occur in your late teens or early adulthood.

Keep reading to know more about the appearance of PPP, its causes, diagnoses, available treatment options, prevention, and related conditions. 

Penile Pearly Papules Symptoms 

Penile pearly papules (PPP) are common and harmless bumps around the glans penis (tip or head of the penis). They are a normal skin variation and do not affect how the penis feels or functions. They have the following characteristics.

• Appearance and location: The most noticeable sign of PPP is the presence of tiny, raised bumps around the head of the penis. They are typically very small, and often less than 1-4 millimeters (mm).
• Color: PPPs are typically pearly white or flesh color and often blend in with the skin's natural color on the penis. They may be slightly lighter or darker than the surrounding skin. But they don’t cause redness or inflammation (swelling).
• Pattern: PPP typically appear in a distinctive pattern, forming one or two rows or circles around the edge of the penis glans. 
• Painless: These bumps do not cause pain, discomfort, or itching.
• No fluid discharge: PPP do not produce any fluids, pus, or discharge. 

The appearance can vary from person to person. Some people have tiny, less noticeable pumps, while others have slightly larger or prominent ones. 

What Causes Penile Pearly Papules? 

The exact cause of PPP is not known. Some consider them a vestigial remnant (something on the body that served a purpose for previous generations but no longer does). However, experts do know they are not the result of an infection or illness.

Risk Factors 

PPP typically develops during or after puberty during the teenage years or young adulthood (around ages 18-24). 

Most studies do not show a racial risk factor. However, one study shows a higher rate in African-American males.

While most studies show PPP is less common among circumcised males, this is not true in all studies. 

How Is Pearly Penile Papules (PPP) Diagnosed?  

Typically, a healthcare provider can diagnose PPP by physically examining the bumps. It does not require specialized testing. The following is an example of the diagnosis process.

• History: The provider asks questions about your medical history, sexual activity, symptoms such as pain or itching, and concerns about the genital area or the bumps.
• Physical exam: The provider will closely inspect the papules, looking at the size, shape, color, and pattern of the bumps. 
• Dermoscopy: If the provider needs to look at the bumps more closely, they may use a dermoscopy. This handheld, non-invasive tool helps them magnify or light up the skin. A dermoscopy resembles a magnifying glass, microscope, or a small telescope. 
• Biopsy (rare): Providers may recommend a biopsy in rare cases. This is a small sample of the tissue they use to examine the cells under a microscope in the lab. It’s not a common test for PPP.

The provider will also perform a differential diagnosis by considering other conditions similar to PPP. They differentiate it from other conditions by key PPP characteristics like the pattern (row or circle) and location (glans penis), and lack of other symptoms (like itching or pain). 

Healthcare providers differentiate PPP from other conditions, such as:

• Genital warts: Genital warts are a sexually transmitted infection (STI) due to a virus called the human papillomavirus (HPV). These flesh-colored bumps have a rough, irregular surface, often similar to a cauliflower. They can occur anywhere in the genital area, including the penis, scrotum (sac that holds the testicles), or anus (area around where poop exits the body). This is in contrast to PPP, which have a smooth texture and form in a row or circle around the tip of the penis. 
• Molluscum contagiosum: This is a viral infection that causes small, flesh-colored, dome-shaped bumps. They can appear in the genital area and other parts of the body. Molluscum contagiosum have a rough texture and a central dimple or indentation. 
• Fordyce spots (sebaceous hyperplasia): These are enlarged oil glands that cause small, flesh-colored, or yellowish bumps. They are typically smaller than PPP and can occur on the shaft as well as the head of the penis. 
• Lichen nitidus: This is a rare skin condition that causes shiny, flesh-colored, pin, or red flat bumps. They typically occur in clusters and are no larger than the head of a pin. Their shininess helps providers differentiate them from PPP.
• Infections: Infections typically cause other symptoms like drainage, redness, swelling, discomfort, or itching.
• Folliculitis: Folliculitis is when a hair follicle becomes blocked and inflamed. You may also hear people call it an ingrown hair. It has a more random distribution than PPP and can occur on the penis shaft or anywhere hair follicles are present.  

Treatments for Pearly Penile Papules 

PPP are harmless and often resolve with age. They will not change and turn into something worse, so treatment is not typically necessary.

Even though they are harmless, they are the most common reason males see a dermatology (skin) healthcare provider. 

Some wish to have them removed for cosmetic reasons (not liking their appearance) which can harm a person’s self-esteem. Cosmetic concerns are more common for those who have moderate-to-larger-sized PPP. Others are concerned that their sexual partners will mistake them for another condition such as genital warts.

Healthcare specialists such as dermatology (skin) or urology (genital urinary) providers can remove them through.

• Cryotherapy (liquid nitrogen freezing)
• Laser therapy (using beams of light to resurface the skin)
• Shave removal (a healthcare provider uses a specialized surgical razor to remove growths just below the skin surface)

Laser therapy can cause mild bleeding and complications such as scarring, skin discoloration, or infection. But most people heal within a week or two without complications.

How to Prevent Penile Pearly Papules 

There is no way to prevent PPP. They are not the result of anything you do or don’t do. PPPs are just part of your skin. Factors like hygiene or sexual activity do not play a role in the development of PPP. They are also not due to poor hygiene.

Related Conditions

PPP are a normal skin variation. They do not cause discomfort, cause complications, or have any related conditions. 

PPP are benign, meaning they are not cancerous, harmful, or dangerous. They do not pose any health risk and having them does not increase the likelihood of developing other medical conditions.

Many people mistake PPP for genital warts. This similarity in appearance can cause distress in sexual relationships and be why a person wishes to have a provider remove PPP. While people can have both genital warts and PPP, they are not related. Having genital warts only occurs in about 1% of those with PPP.

Living With Pearly Penile Papules

Having pearly penile papules does not affect your overall, sexual, or reproductive health. If you are unsure if the bumps are PPP, make an appointment with a healthcare provider. Practice safe sex by using a condom in the meantime. Continue cleaning your penis as you usually would. 

Also, if you have PPP and they worry, bother, or embarrass you, talk with a healthcare provider. They can give you more information or refer you to a specialist who can remove them.