Abstract

Pearly penile papules (PPPs) are benign angiofibromatous proliferations characterized by ectopic sebaceous gland hyperplasia and stromal fibrosis, classically arranged in a dome-shaped distribution around the corona of the glans. Despite their non-infectious and physiologic nature, PPPs are frequently mistaken for sexually transmitted infections, contributing to heightened patient concern and demand for cosmetic intervention. Laser therapy has emerged as the leading treatment modality, offering precise ablation with controlled thermal confinement and favorable cosmetic outcomes. Ablative fractional carbon dioxide (CO₂) lasers (10,600 nm) deliver deep dermal penetration with marked coagulation, facilitating complete lesion removal but at the cost of longer re-epithelialization times and greater risk for pigmentary alteration. In contrast, Erbium-doped Yttrium Aluminum Garnet (Er:YAG) lasers (2940 nm) provide more superficial ablation with minimal collateral thermal damage, supporting faster healing and reduced downtime, though often necessitating multiple sessions for optimal efficacy. Emerging technologies, including picosecond-domain lasers, thulium fiber lasers, and fractional radiofrequency microneedling, are being investigated for their potential to selectively target papular structures with enhanced precision and reduced recovery times. Integration of real-time thermal feedback systems, robotics-assisted guidance, and AI-optimized energy delivery parameters may further advance procedural accuracy and safety. With advances in laser physics, device miniaturization, and precision energy delivery, cosmetic treatment of pearly penile papules reflects a convergence of aesthetic intent and microsurgical control, demonstrating how targeted technologies can refine tissue interaction in anatomically delicate, highly specialized procedures.

Keywords

pearly penile papules (PPPs), Er:YAG lasers, pulsed dye lasers, non-ablative lasers, sexually transmitted infection, microsurgical control