Painless non-itching yellow-white spots on genital mucosa

A 28 year old white man presented to the dermatology clinic because of raised, yellow-white coloured skin lesions on the glans of his penis that had been increasing in number over two years. Repeated attempts had been made to cure the affected areas with topical antimycotic drugs, antibiotics, and virostatic agents.

Macroscopic inspection showed a penile mucosa covered by densely aggregated yellow-white, minute papules. Lesional swabs to look for colonisation with bacteria, fungi, or viruses were unremarkable.

Questions

1 What is the likely diagnosis?

2 What is the causative pathological mechanism?

3 What treatment would you recommend?

4 Which differential diagnoses have to be considered?

Answers

1 What is the likely diagnosis?

Fordyce €™s spots (also known as Tyson €™s glands or ectopic sebaceous glands).

2 What is the causative pathological mechanism?

They are caused by sebaceous glands that are not linked to hair follicles.

3 What treatment would you recommend?

Treatment is unnecessary.

4 Which differential diagnoses have to be considered?

Pearly penile papules, milia, flat warts, condylomata acuminata, and planar xanthomas.

Patient outcome

The benign nature of the alterations was explained to the patient in detail. All topical treatments were stopped.

[Link to free BMJ article for full text with long answers, images, and references]

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