Dermatology Online Journal

Eruptive angiokeratomas on the glans penis
Jamison D Feramisco MD PhD¹, John B Fournier¹, Daniel C Zedek MD¹, Suraj S Venna MD²
Dermatology Online Journal 15 (10): 14

1. Department of Dermatology, University of California, San Francisco, San Francisco, California
2. Washington Cancer Institute, Washington, DC. Suraj.s.venna@medstar.net

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Abstract

Angiokeratomas are benign proliferations of dilated thin-walled blood vessels in the upper dermis with overlying epidermal hyperkeratosis. There are several clinical variants of angiokeratomas: 1. Fordyce: smooth reddish-purple papules on scrotum or vulva; 2. Mibelli: hyperkeratotic papules on fingers or toes, solitary, multiple, or circumscriptum (grouped papules usually on an extremity); 4. angiokeratoma corporis diffusum, widespread papules that are a manifestation of one of several inherited lysozomal storage diseases. Herein, we report a rare case of multiple angiokeratomas of Fordyce on the corona of the glans penis.

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Case

A 62-year-old man with a history of hypertension, hyperlipidemia, and benign prostatic hyperplasia, was referred to our clinic for evaluation of asymptomatic, but anxiety-provoking, red papules on the glans penis. The papules developed abruptly and increased over a 4-month period, followed by a static period over the last 2 months, with no new lesions. The patient denied sexual contact in the past 5 years.

Figure 1	Figure 2
Figure 1. Clinical photographs of our patient. (A) and (B), numerous small blue-purple asymptomatic papules on the dorsal corona of the glans penis. Figure 2. Histopathologic findings from a punch biopsy. (A) and (B), Hematoxylin and eosin stain reveals dilated blood vessels with thin walls and an overlying epidermis demonstrating hyperkeratosis and acanthosis.

A total body skin examination was completed that revealed greater than 30 firm, non-tender, round, blue-purple papules ranging in size from 0.5 mm to 2 mm encircling the coronal arc of the glans penis (Fig. 1). The scrotum was uninvolved and inguinal lymphadenopathy was absent. A punch biopsy from a papule revealed a polypoid proliferation with prominent dilated blood vessels with thin walls and lumens filled with erythrocytes. The overlying epidermis displayed hyperkeratosis and acanthosis with rete ridges encircling dilated vessels (Fig. 2).

Upon confirmation of this benign entity, the patient deferred treatment and the papules remained stable in number at a 6-month follow-up visit.

Comment

Angiokeratomas of the scrotum were first described by Fordyce in 1896, in a 60-year-old man with bilateral varicoceles [1]. Such lesions are commonly found on the scrotum as well as the vulva in women, but also to a lesser extent in the groin, thighs, and abdomen [2]. Angiokeratoma of Fordyce usually develops in late adulthood or in elderly patients. Angiokeratomas present as asymptomatic lesions in the majority of patients, although cases involving bleeding, pain, and pruritus have been reported [3]. Because the condition is benign, the presence of symptoms along with the patient's satisfaction regarding cosmesis guides the treatment approach. Several treatment modalities exist, including surgical excision, electrodessication, and laser therapy.

Our case is unusual in that angiokeratomas arising solely on the glans penis is an extremely uncommon presentation. A thorough history and physical exam revealed no evidence in support of increased local hypertension in this patient. The etiology of such lesions remains unknown, but increased local venous hypertension and degeneration of elastic tissue in dilated vessels are hypothesized as causal. Fordyce angiokeratomas have been associated with inguinal hernia, varicocele, prostatitis, lymphgranuloma venereum, thrombophlebitis, and carcinoma of the bladder [4]. Although no established protocol exists for the management of angiokeratomas involving the glans penis, Bechara et al. describe excellent cosmetic results with the use of combined treatment with Erbium: Yag and 532 nm KTP laser [5].

References

1. Fordyce JA: Angiokeratoma of the scortum. J Cutan Genitourin Dis 14: 81-87, 1896.

2. Cohen PR, Young AW Jr, and Tovell HM: Angiokeratoma of the vulva: diagnosis and review of the literature. Obstet Gynecol Surv 44: 339-346, 1989. [PubMed]

3. Taniguichi S, Inoue A, and Hamada T: Angiokeratoma of Fordyce: a cause of scrotal bleeding. Br J Urology 73: 589-590, 1994. [PubMed]

4. Erkek E, Basar MM, Bagci Y, Karaduman A, Bilen CY, Gokoz A. Fordyce angiokeratomas as clues to local venous hypertension. Arch Dermatol. 2005 Oct;141(10):1325-6. [PubMed]

5. Bechara FG, Jansen T, Wilmert M, Altmeyer P, Hoffmann K. Angiokeratoma Fordyce of the glans penis: combined treatment with erbium: YAG and 532 nm KTP (frequency doubled neodymium: YAG) laser. J Dermatol. 2004 Nov; 31 (11): 943-5. [PubMed]

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