II. Causes: Papulosquamous

  1. Psoriasis
    1. Red Plaques with overlying white or silver scale
    2. Isolated involvement of the genital skin without Plaques elsewhere would be rare
    3. Distinguish from Bowen Disease (or Penile Cancer in Situ)
    4. Responds to Topical Corticosteroids
  2. Pearly Penile Papules
    1. Small skin-colored, dome-shaped lesions form a ring at the base of the glans penis (at coronal sulcus)
    2. Asymptomatic
    3. Distinguish from Lichen Nitidus, Angiokeratomas

III. Causes: Inflammatory

  1. Lichen Nitidus
    1. Tiny (1 mm), asymptomatic hypopigmented Papules
    2. Often found on non-genital skin
    3. Distinguish from Genital Herpes and pearly penile Papules
  2. Lichen Planus
    1. Pruritic, sore, flat-topped polygonal violaceous Papules
    2. Often found on non-genital skin
    3. Distiniguish from Secondary Syphilis
    4. Responds to Topical Corticosteroids
  3. Lichen Sclerosus of foreskin (Balanitis Xerotica Obliterans)
    1. Cellophane-like hypopigmented, thinned foreskin
    2. May result in Phimosis, Urinary Outflow Obstruction, painful Erections
    3. Pruritus and bleeding may also occur
    4. Distinguish from Scleroderma and Penile Cancer
    5. Responds to Topical Corticosteroids

IV. Causes: Vascular

  1. Angiokeratoma
    1. Red-blue Papules along the margin of the glans penis
    2. May also involve Scrotum, thigh or abdominal skin
    3. Distinguish from Pearly Penile Papules

V. Causes: Infectious

VI. Causes: Neoplastic

  1. Penile Cancer in Situ (Bowen Disease)
    1. Plaque or penile ulcer most typically involving glans penis or foreskin
    2. Broad differential (e.g. Psoriasis, Lichen Sclerosus, Genital Herpes, Secondary Syphilis, Balanitis)
  2. Penile invasive squamous cell cancer
    1. Papulosquamous or exophytic lesions lesions on the penis
    2. Distinguish from condyloma

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