Indian Journal of Dermatology
  Publication of IADVL, WB
  Official organ of AADV
Indexed with Science Citation Index (E) , Web of Science and PubMed
 
Users online: 1446  
Home About  Editorial Board  Current Issue Archives Online Early Coming Soon Guidelines Subscriptions  e-Alerts    Login  
    Small font sizeDefault font sizeIncrease font size Print this page Email this page


 
Table of Contents 
CORRESPONDENCE
Year : 2021  |  Volume : 66  |  Issue : 4  |  Page : 407-409
Angiokeratoma of Fordyce on the Shaft of Penis with Underlying Venous Malformation


1 Department of Skin and VD, Pt. B. D. Sharma PGIMS, Rohtak, Haryana, India
2 Department of Pathology, Pt. B. D. Sharma PGIMS, Rohtak, Haryana, India

Date of Web Publication17-Sep-2021

Correspondence Address:
Barnita Saha
Department of Skin and VD, Pt. B. D. Sharma PGIMS, Rohtak, Haryana
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijd.IJD_678_20

Rights and Permissions



How to cite this article:
Saha B, Gupta I, Aggarwal K, Kataria SP. Angiokeratoma of Fordyce on the Shaft of Penis with Underlying Venous Malformation. Indian J Dermatol 2021;66:407-9

How to cite this URL:
Saha B, Gupta I, Aggarwal K, Kataria SP. Angiokeratoma of Fordyce on the Shaft of Penis with Underlying Venous Malformation. Indian J Dermatol [serial online] 2021 [cited 2021 Dec 6];66:407-9. Available from: https://www.e-ijd.org/text.asp?2021/66/4/407/326137




Dear Editor,

A 25-year-old unmarried man presented with multiple asymptomatic skin colored to reddish-purple raised skin lesions on the shaft of the penis since 4 years. These lesions had started abruptly as small spots and had gradually increased in size and number. There was an occasional history of bleeding on touching the lesions. There was no history of high-risk sexual behavior in the patient and he had not received any treatment. Cutaneous examination revealed a plaque of size 3 cm × 2 cm with multiple studded skin colored to reddish-purple hyperkeratotic papules of size 2–4 mm on the margin located on the middle aspect of the shaft of penis on the dorsal surface [Figure 1]. Lesions were soft to firm in consistency, nontender, slightly compressible, nonpulsatile, and free from the underlying structure. There was no involvement of the scrotum and inguinal lymphadenopathy was absent. A punch biopsy was taken from one of the papules that revealed epidermal hyperkeratosis and dilated blood vessels in the papillary dermis [Figure 2]. Ultrasonography of abdomen, pelvis, and genital area was performed, which showed mild thickening of skin and subcutis on the dorsum of the penile shaft with slightly raised echogenicity and slow flow on color Doppler in the penile shaft area suggestive of venous malformation [Figure 3] and [Figure 4]. On the basis of clinical, histopathological, and radiological features, a diagnosis of angiokeratoma of Fordyce on the shaft of the penis with underlying venous malformation was made.
Figure 1: Plaque with multiple studded skin colored to reddish-purple hyperkeratotic papules on margin suggestive of angiokeratoma of Fordyce on the middle aspect of the shaft of penis on the dorsum

Click here to view
Figure 2: Epidermis showing hyperkeratosis. The upper dermis shows dilated blood vessels. (Hematoxylin and eosin stain, 10×)

Click here to view
Figure 3: Mild thickening of the skin and subcutis on the dorsum of the penile shaft with slightly raised echogenicity on normal ultrasonography

Click here to view
Figure 4: Slow flow on color Doppler in the penile shaft area suggestive of venous malformation

Click here to view


Angiokeratomas are benign cutaneous vascular proliferations characterized by dilated thin-walled blood vessels lying in the upper dermis, with hyperkeratosis at the surface. Several clinical variants of angiokeratomas exist: the Mibelli type, the solitary and multiple (papular type), the Fordyce type, the angiokeratoma circumscriptum, and the angiokeratoma corporis diffusum. Solitary or multiple (papular types) usually involves the lower extremities.[1] Angiokeratoma corporis diffusum is associated with a systemic disease such as Fabry's disease or fucosidosis.[2] Angiokeratoma circumscriptum usually presents as papules with a tendency to confluence into plaques.[3] Angiokeratoma of Mibelli characterized by papules or verrucoid nodules is more commonly present in men and involves bony prominences.[4] Angiokeratomas of Fordyce is most often observed on the scrotum or vulva but has also been noted on the glans penis and clitoris.[1] Angiokeratomas of the penis are rare vascular lesions that are most commonly present as multiple lesions along the coronal rim of the glans penis.[5] Our patient presented with multiple angiokeratoma on the shaft of penis; the morphologic features of the lesion were most suggestive of angiokeratoma of Fordyce. There are only six cases of angiokeratoma of Fordyce on shaft of penis reported in the literature as summarized in [Table 1], but literature search could not reveal any similar case in our search efforts like that of angiokeratoma on the shaft of the penis with underlying venous malformation.[2],[8],[9],[10],[11] The pathogenesis of genital angiokeratomas remains to be definitively established. Among the proposed hypothesis are congenital defects in venule walls, malformations, and acquired injury to vessel walls due to trauma or long-standing venous hypertension.[6] The common clinical differentials affecting this area include seborrheic keratoses, melanocytic nevi, dermatofibroma, bowenoid papulosis, molluscum contagiosum, condyloma acuminata, and lymphangioma circumscriptum. The histopathological differentials include lymphangioma (dilated lymphatics with clear fluid in dermis), pyogenic granuloma (polypoidal outgrowth of angiomatous tissue with mixed inflammatory cells in deeper part), and cherry angioma, hemangioma (lacks epidermal hyperkeratosis and acanthosis). The treatment of genital angiokeratomas mainly consists of observation as they are benign and asymptomatic. However, for lesions that are cosmetically undesirable or symptomatic, multiple treatment modalities are available such as cryotherapy, electrocoagulation, laser, sclerotherapy, and surgical excision.[7] We report our case because of the rarity of its occurrence.
Table 1: Cases of angiokeratoma on the shaft of penis in literature

Click here to view


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Keen MA, Hassan I. Eruptive angiokeratomas on the glans penis. Indian J Dermatol 2014;59:424.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Baumgartner J, Simaljakova M. Genital angiokeratomas of Fordyce 595-nm variable-pulse pulsed dye laser treatment. J Cosmet Laser Ther 2017;19:459-64.  Back to cited text no. 2
    
3.
Saha M, Barlow R, Bunker CB. Angiokeratoma circumscriptum of the penis. Br J Dermatol 2006;154:775-6.  Back to cited text no. 3
    
4.
Sahin MT, Turel-Ermertcan A, Ozturkcan S, Turkdogan P. Thrombosed solitary angiokeratoma of Mibelli simulating malignant melanoma: The importance of dermoscopy in differential diagnosis. J Eur Acad Dermatol Venereol 2006;20:102-4.  Back to cited text no. 4
    
5.
Basu P, Cohen PR. Penile angiokeratoma (Peaker): A distinctive subtype of genital angiokeratoma. Cureus 2018;10:e3793.  Back to cited text no. 5
    
6.
Beutler BD, Cohen PR. Angiokeratoma of the glans penis. Skinmed 2017;15:343-7.  Back to cited text no. 6
    
7.
Burnett CT, Kouba DJ. A rare case of congenital angiokeratoma of the glans penis treated using a 595-nm pulsed dye laser. Dermatol Surg 2012;38:2028-30.  Back to cited text no. 7
    
8.
Ibrahim SM. Pulsed dye laser versus long pulsed Nd:YAG laser in the treatment of angiokeratoma of Fordyce: A randomized, comparative, observer-blinded study. J Dermatolog Treat 2016;27:270-4.  Back to cited text no. 8
    
9.
Ghosh SK, Ghosh S, Agarwal M. Multiple giant angiokeratoma of Fordyce on the shaft of the penis masquerading as keratoacanthoma. An Bras Dermatol 2015;90(3 Suppl 1):150-2.  Back to cited text no. 9
    
10.
Ozdemir M, Baysal I, Engin B, Ozdemir S. Treatment of angiokeratoma of Fordyce with long-pulse neodymium-doped yttrium aluminium garnet laser. Dermatol Surg 2009;35:9297.  Back to cited text no. 10
    
11.
Pianezza ML, Singh D, Van der Kwast T, Jarvi K. Rare case of recurrent angiokeratoma of Fordyce on penile shaft. Urology. 2006;68:891.e1-3.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1]



 

Top
Print this article  Email this article
 
 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (1,319 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  


    References
    Article Figures
    Article Tables

 Article Access Statistics
    Viewed403    
    Printed8    
    Emailed0    
    PDF Downloaded22    
    Comments [Add]    

Recommend this journal