ARTICLE | RADIOFREQUENCY | appearance, and that the condition created an
unnecessary topic of discussion with prospective sexual partners. On physical examination, multiple 1 mm pearly-to-skin
coloured papules were noted in a string-like formation distributed along the corona of glans penis and around the frenulum (Figure 1). Figure 2 shows the patient immediately following treatment with radiofrequency surgery. Figure 3 shows the patient 2 weeks following treatment with no visible scarring or discolouration. The patient reported no change to skin sensitivity. The patient underwent a single treatment.
Results The patient had a follow-up visit 2 weeks after a single treatment. He reported localised redness and swelling in the treatment area for approximately 4–5 days post-procedure (Figure 2). No significant pain or loss of sensation had been reported. On physical examination, the treatment area looked smooth with no significant scarring or discolouration. At 1-year follow-up, the patient reported no recurrence of papules. During the course of 3 years, over 100 cases of PPP treatments have been performed by the author. No recurrences have been reported
Discussion The majority of dermatologic surgeons will generally use a CO2
Key points
n Pearly penile papules are benign angiofibromas. The main reason for treatment is cosmetic and psychological discomfort
and 2940 nm Er:YAG lasers
n Published methods of removal include that with CO2
, Fraxel 1550™
n A new, more cost-effective method of treatment for PPP is radiofrequency ablation
n Radiofrequency ablation is safe, fast and produces excellent results in a single treatment
n Advanced surgeon’s training is required to achieve optimum results
passed on to the patient, limiting the number of patients who can afford treatment. Radiofrequency surgery is inexpensive by comparison, costing a fraction of treatment with a laser. The major advantage of using a radiofrequency device such as that described by the author, is its cost. The Dento-Surg RF device costs approximately $3000 when purchased new from the manufacturer. In comparison, new CO2
or 2940 nm
Er:YAG lasers cost between $60 000 to over $100 000, for example. Radiofrequency devices have very limited maintenance, if any. Laser devices require regular calibration and maintenance of expensive parts. The author has performed over 100 radiofrequency
surgeries for the removal of PPP to date, with no history of any significant side-effects, such as scarring, skin discolouration, or a change of sensation in the treatment area.
Since the described procedure is
operator-dependent, it requires advanced skills in order to avoid the removal of tissue beyond the papules. Inexperience of working with radiofrequency devices in dermatologic surgery may be a barrier to some surgeons to use this method with confidence. One might want to start using radiofrequency surgical devices first for less advanced dermatologic procedures, such as the removal of larger skin lesions, in order to develop the necessary skills.
laser or fractional resurfacing for the treatment
of PPP. While these treatments have proven reliable and effective, there are limitations associated with their use. For the patient, the procedures are expensive and require either weeks of treatment in the case of fractional resurfacing, or the possibility of damage to the tissue surrounding the papules, in the case of CO2
laser
treatment. Radiofrequency surgery offers quicker recovery, a lower chance of accidental damage, and full treatment in just one session. For the surgeon, the cost of lasers ® both CO2
and fractional photothermolysis ® is high and those costs are
Conclusions Radiofrequency surgery for the treatment of PPP is a convenient and moderately easy to perform method of treatment, which has many potential advantages over CO2
laser treatment. This procedure is proving time and again to provide a
Figure 3 The patient 2 weeks after treatment. The patient reported no loss of sensation, no discolouration and no destruction to the surrounding tissue
painless, one-time treatment option for patients displaying PPP. Unlike other treatments, it is relatively inexpensive, allows for quick healing and does not require extensive follow-up care or treatment.
Declaration of interest The author reports no conflicts of interest. The author alone is responsible for the content and writing of this article.
All figure images ç Yuriy Yagudin.
References
1. Magid M, Garden JM. Pearly penile papules: treatment with the carbon dioxide laser. J Dermatol Surg Oncol 1989; 15(5): 552–4
2. Lane JE, Peterson CM, Ratz JL. Treatment of pearly penile papules with CO2 laser. Dermatol Surg 2002; 28(7): 617–8
3. Rokhsar CK, Ilyas H. Fractional resurfacing for the treatment of pearly penile papules. Dermatol Surg 2008; 34(10): 1420–2
4. Sonnex C, Dockerty WG. Pearly penile papules: a common cause of concern. Int J STD AIDS 1999; 10(11): 726–7
5. Agha K, Alderson S, Samraj S et al. Pearly penile papules regress in older patients and with circumcision. Int J STD AIDS 2009; 20(11): 768–70
6. Baumgartner J. Erbium: yttrium-aluminium-garnet (Er:YAG) laser treatment of penile pearly papules. J Cosmet Laser Ther 2012; 14(3): 155–8
50 ❚
July/August 2012 |
prime-journal.com
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84