Therapeutic efficacy of topical liquid nitrogen cryotherapy in pearly penile papules

Objectives: Pearly penile papules (PPP) are small dome-shaped to filiform skin-colored papules that are typically located on the coronal sulcus of the glans penis. Present modalities of treatment include ablation using carbon dioxide laser, electrodessication with curettage, and excision. The present study was undertaken to evaluate the efficacy of topical liquid nitrogen cryotherapy with the dipstick method as a therapeutic modality for the treatment of PPP. Materials and Methods: Forty patients with the clinical diagnosis of PPP were enrolled for the study. After cleaning the involved area with povidone-iodine solution, the appropriate autoclaved applicators were dipped in liquid nitrogen, applied on the involved area, and repeated to complete two freeze-thaw cycles of 2 s each. All the patients were subjected to three applications at weekly intervals (0, 1, and 2 weeks). Follow-up were done fortnightly for up to 12 weeks. Results: The majority of the patients were in the age group 20 – 40 years. A significant number of patients (35%) presumed these lesions to be associated with sexually transmitted infection. Most of the patients 29 (72.5%) had a duration of lesion <1 year, 10 (25%) patients had lesions since 1 – 5 years, while 1 (2.5%) patient had lesions since 30 years. Complete resolution of lesions was seen in 85% of patients. Conclusion: Cryotherapy with liquid nitrogen is an effective modality in the treatment of PPP. Advantages are ease of use, low cost, good cosmetic results, high cure rate, no requirement of anesthesia, and rarity of complications, and above all patients of any age can be treated.