White spots on penis could be very embarrassing for every man. These white spots could be due to several conditions and are usually not due to sexually transmitted infection. These spots could sometime be just a harmless spot, but if you are worried please consult your doctor. This article is limited to white spots on penis that are usually flat and not raised. Please refer to raised bumps on penis for other conditions.
Vitiligo which involves oral and genital mucosa is classified as mucosal vitiligo. Mucosal vitiligo can be seen in any areas like lips, glans penis, prepuce, and anal. In most cases vitiligo may also be present in any other parts of the body but sometimes it can also be isolated to these genital areas. Mucosal vitiligo is often difficult to treat and is resistance to medications.
Lichen sclerosus involving penis is commonly a presentation of uncircumcised men although it can occur in circumcised individuals.The classic presentation of genital lichen sclerosus is atrophic white patches or plague but it may also manifests as scaly patches with telangiectasia and sparse purpura. Early genital lichen sclerosus may be confused with vitiligo. If there is clinical confusion biopsy is helpful. Patients with genital Lichen sclerosus may carry risk of developing squamous cell carcinoma of penis.
Scarring is also one of the common causes of white spots on penis. Injuries and infection of the penis usually heals with scarring that are either temporary or permanent depending on the type of injuries or infection. These injuries may leave hypopigmented or hyperpigmented scar on the penis.
Post-inflammatory hypopigmentation (PIH) is also common cause of white spots on penis. Any infection or inflammation on penis may result in post inflammatory hypopigmentation.
Pityriasis versicolor is another cause of hypopigmentation on penis. PV is caused by yeast and usually involves other parts of the body in addition to genital areas. Topical antifungal medications applied over 4-6 weeks may resolve the condition while it may take over 6 months to 1 year or more for hypopigmentation to return to its normal color.
Bier spots are small, irregular, hypopigmented spots that are usually found on the arms and legs of young adults. It can sometime develop on genital areas like penis. They are thought to be caused by vasoconstriction in small vessels which may be due to anatomical and functional damage to the small vessels of the skin. Some papers have associated biers spots with systemic disease such as scleroderma renal crisis, lymphoma and mixed cryoglobulinemia.[1,2]
Other condition that may present as white spots on penis are listed below:
- Viral warts
- Cicatricial pemphigoid
- Squamous hyperplasia
- Extramammary Paget disease
- Mycosis fungoides
- Peyrot I, Boulinguez S, Sparsa A, et al. Bier’s white spots associated with scleroderma renal crisis. Clin Exp Dermatol 2007;32: 165-7.
- Binois R, Galliot C, Audia S, et al. Multiple anaemic macules and diffuse erythrocyanosis revealing mixed cryoglobulinaemia. Eur J Dermatol 2011;21:269-70. Fan YM, Yang YP, Li W, et al. Bier spots: six case reports. J Am Acad Dermatol 2009;61:e11-2.