Successful Treatment of Pearly Penile Papules with Carbon Dioxide Laser Resurfacing After Local Anesthesia in an Adolescent Patient

Abstract

Pearly penile papules (PPP) can cause significant psychological morbidity. Herein we report the successful use of a macrofractionated carbon dioxide laser at full-field ablative density settings for the treatment of PPP in a 17-year-old boy using local anesthetic alone. Our experience leads us to believe that PPP can be successfully treated in the pediatric and adolescent populations using this novel and relatively noninvasive technique.

Management of Pearly Penile Papules: A Review of the Literature

“…Fully and fractionally ablative CO 2 laser can be performed when treating PPPs (Table 1). 1,13 -18 Fractional ablative CO 2 lasers, when compared with nonfractioned ablative lasers, are associated with a decreased risk of complications like infection, erosions, ulceration, scarring, and postinflammatory dyspigmentation. Fractional therapy also has the added benefit of shortened healing time, which translates into less downtime for the patient post-treatment.…”

“…Fractional therapy also has the added benefit of shortened healing time, which translates into less downtime for the patient post-treatment. 1,13,14,18…”

“…Each treatment consisted of an energy fluence of 100 to 125 mJ/cm 2 and frequency of 125 Hz at 2 months (Ultrapulse, Lumenis Inc., Santa Clara, CA, United States) 1 Another study reported more than 90% resolution of PPPs after a single fractional CO 2 treatment (Active Fx, Ultrapulse Encore, Lumenis, Yokneam, Israel). 18 A more recent study used a fractionated CO 2 laser (Synderon Candela Wayland, MA, United States) to perform a point-by-point ablation on 10 patients with PPPs. The settings used in that study were an energy density of 10 mJ/cm 2 , output power of 60 W, and laser pulse mode.…”

Diagnosis and Management of Pearly Penile Papules

“…The continuous wave mode of the CO 2 laser provides better hemostasis and operative field visualization than the short pulse mode (McKinlay, Graham, & Ross, 1999). Using the fractionated CO 2 laser, one group reported more than 90% resolution after a single treatment (Krakowski, Feldstein, & Shumaker, 2015). Another group concluded that two to three treatments were sufficient to completely resolve lesions without adverse effects in both light and dark skin types (Gan & Graber, 2015).…”

“…Another group concluded that two to three treatments were sufficient to completely resolve lesions without adverse effects in both light and dark skin types (Gan & Graber, 2015). While the CO 2 laser exposes the underlying tissue, reepithelialization generally occurs within 5 to 7 days (Krakowski et al, 2015). Nevertheless, the procedure requires anesthesia and increases the risk of scarring and infection.…”