Smegma pearl: A benign penile lesion in infants

Abstract

Key clinical message

Provide comprehensive knowledge to healthcare practitioners regarding the benign characteristics of smegma pearls, aiming to alleviate anxiety and minimize unwarranted medical interventions.

Abstract

Penile nodules in infant are distressing to the mother and also cause diagnostic dilemmas to primary care physician. Most of the penile nodules are benign and the only treatment is reassurance to the mother. Smegma pearl occurs due to accumulation of the desquamated epithelial cells under the penile foreskin and are visualized as yellowish white lumps. We present a similar case who presented to the primary health centre at rural Nepal.

1. INTRODUCTION

Smegma pearls are benign collections of smegma that can develop in the glans of uncircumcised boys. ¹ While the condition is typically asymptomatic and resolves on its own over time, it can cause anxiety for parents and caregivers. ² In this case report, we present the case of a 2‐month‐old male infant who was brought to a primary health center by his mother, with a white nodule on his penis.

2. CASE PRESENTATION

A 2‐month‐old male infant was brought to a primary health center by his apprehensive mother who was concerned about a white nodule on his penis. The infant was voiding without difficulty and breastfeeding well. No similar lesions were noticed on the rest of the body or mucosal surfaces. There was no maternal history of sexually transmitted infections, and all the initial infection screenings, including HIV/hepatitis B, C/syphilis, were negative. The mother denied any trauma. The baby was born at full term to a multigravida mother via spontaneous vaginal delivery with a birth weight of 3.5 kg, head circumference of 36 cm, and length of 51 cm. The clinical examination of the baby was unremarkable except for a white nodular lesion on the tip of the penis noted. Evaluation of the external genitalia revealed a 0.5 × 0.5 cm‐sized, round, yellowish‐white nodule over the penile foreskin. (Figure 1) The lesion was non‐tender and soft in consistency. After discussing the diagnosis with the urologist, the mother was initially counseled regarding the benign nature of the condition. However, despite attempts at further counseling, the mother remained apprehensive and could not be fully reassured. So manual expression of the nodule by gentle pressure was performed, revealing white cheesy material and further confirming the diagnosis of Smegma pearl. At 6‐month follow‐up visit, the nodular swelling has resolved and child was doing well.

FIGURE 1.

Whitish nodule on the tip of the penis.

3. DISCUSSION

Smegma pearls are small, yellowish‐white lumps that can develop in the glans of uncircumcised boys due to a buildup of smegma, typically between the preputial membrane and the base of the glans penis. ¹ Smegma has a typical slimy odor, consisting of epithelial debris, fat, and proteins. ³ While smegma is not uncommon in uncircumcised boys, it is rare to occur in circumcised individual with only single case reported in literature. ⁴ In affected individuals, the prepuce exhibits a partial retractability while the urethra remains unaffected. ¹ A diverse range of bacterial species may inhabit the preputial sac, thereby predisposing them to bacterial superinfection. ⁴ With regard to management, the primary therapeutic modality for smegma pearls involves offering reassurance and counseling to the patient, with the expectation that spontaneous separation will occur over time. ²

The differential diagnosis of the swelling presenting in the tip of the penis usually includes preputial Epstein pearls, preputial cysts, median raphe cysts and smegma stone(smegmalith). ¹ Those various swelling could easily be differentiated based on the location and age of the child. Preputial Epstein pearls are usually pearly white swelling present over the tip of the penis incidentally found in male newborn and disappear by the seventh day of life. ⁵ Preputial cysts are nodular swellings present under the glans and median raphe cysts are located over the ventral surface of the penis due to tissue trapping during development of the urethral folds. ⁶

Although smegma pearl is best managed conservatively, some physicians advise 6–8 weeks of low‐potency steroids. ¹ In this particular case, the mother harbored apprehensions and reservations regarding the natural course of the condition, and therefore we opted for manual extraction in consultation with a urologist. While it may be argued that such intervention was unnecessary from a clinical standpoint, it was deemed necessary on social grounds to assuage the concerns of the mother.

4. CONCLUSIONS

Smegma pearls, benign accumulations of smegma, primarily develop in the glans of uncircumcised boys and are uncommon in circumcised individuals. The main management approach for smegma pearls is providing reassurance and counseling, as they typically resolve spontaneously. In certain cases, additional treatment options such as low‐potency steroids or manual extraction may be considered, but these interventions are not always necessary from a clinical standpoint. The decision to pursue such treatments should be based on individual clinical circumstances.

AUTHOR CONTRIBUTIONS

Kushal Baral: Writing – original draft; writing – review and editing. Susmita Poudel: Writing – review and editing.

FUNDING INFORMATION

None.

CONFLICT OF INTEREST STATEMENT

The authors have no conflict of interest to declare.

ETHICS STATEMENT

None.

CONSENT

Written consent was obtained from the mother of the patient for the publication of medical report in accordance with the Journal's patient consent policy.

Baral K, Poudel S. Smegma pearl: A benign penile lesion in infants. Clin Case Rep. 2023;11:e7613. doi: 10.1002/ccr3.7613

DATA AVAILABILITY STATEMENT

All the required information is available in the manuscript itself.