Atypical pearly penile papules mimicking primary syphilis.

Several modes of therapy are used for treating PPP, including cryotherapy, electrodesiccation, podophyllin, curettage, and carbon dioxide laser ablation; however, treatment should be reserved for patients who have cosmetic or psychological concerns from the appearance of this benign entity (2). We report on the case of a 41-year-old Caucasian man with a history of several months of two nonpainful, smooth papules with a central depression, elevated borders, and annular shape on the dorsal surface of the penis near the neck (Fig. 1). Physical examination of the genitalia was otherwise unremarkable. Before his referral, the lesions had been misdiagnosed as primary syphilis and treated with penicillin without response. Because of the uncommon presentation and the patient ́s fear of having a sexually transmitted disease, a skin biopsy was performed. Histologic examination revealed dermal ectatic venules embedded in a collagenous stroma with several stellate fibroblasts, recovered by a dome shaped acanthotic epidermis (Fig. 2). These findings matched the histologic features of angiofibroma, and the diagnosis of PPP was established. The benign nature of these lesions was