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55-Year-Old Male with Flat Bumps on Head of Penis

Can you diagnose this case?

David L. Kaplan, MD – 2015 Series Editor

Signs and Symptoms

A 55-year-old man presents with a 4-week history of asymptomatic flat bumps on the head of his penis only. They have slowly appeared, about a week apart, and have since gradually enlarged. He denies any other rash. He denies any new sexual exposure and is reportedly happily married.

What is responsible for these asymptomatic, flat bumps?

Choose one to reveal diagnosis and discussion

Lichen planus
Human papillomavirus (HPV)
Psoriasis
Pityriasis rosea
Dermatophyte infection

Answer: Lichen planus

See the full case at Consultant360

This patient has the flat, well-circumscribed, purplish papules typically seen with lichen planus. He did not show any oral lesions. He responded well to a midpotency steroid cream.

Differential Diagnosis: HPV is reasonable and can be confirmed by shave biopsy if uncertain of the diagnosis. Psoriasis is possible, though more scaling is usually seen. Pityriasis rosea can affect the penis but would affect other areas as well, and again, more scaling would be expected. Dermatophyte infection of the penis is rare, typically seen in immunocompromised hosts (eg, individuals with diabetes) and again, scaling would be expected.

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