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Dermatology

A Pinpoint Orifice on the Glans Penis of a Young Man

Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.

1 Credit CME

JAMA Dermatology

Published Online: March 29, 2023

JAMA Dermatology Clinicopathological Challenge

Article Information and Disclosures

Catalina Hasbún, MD¹;

Ximena Wortsman, MD^2,3,4;

Jorge Navarrete, MD⁵

Author Affiliations

¹Department of Dermatology, Faculty of Medicine, Universidad de los Andes, Santiago, Chile
²Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Santiago, Chile
³Department of Dermatology, Faculty of Medicine, Universidad de Chile, Santiago, Chile
⁴Department of Dermatology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
⁵Department of Dermatology, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana and Universidad del Desarrollo, Santiago, Chile

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A healthy, uncircumcised man in his 30s presented with a 14-year history of dyspareunia and recurrent, purulent discharge from his penis. He had undergone multiple evaluations by dermatologists and urologists and had not responded to systemic antibiotics and topical corticosteroids. Physical examination revealed an erythematous, pinpoint orifice on his glans penis, with peripheral telangiectasias and a linear bluish structure on dermoscopy (Figure, A and B). Ultrasonography revealed a hypoechoic focal zone on the right side of the glans, with multiple hyperechoic bilaminar structures (Figure, C). A biopsy was performed (Figure, D).

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A healthy, uncircumcised man in his 30s presented with a 14-year history of dyspareunia and recurrent, purulent discharge from his penis. He had undergone multiple evaluations by dermatologists and urologists and had not responded to systemic antibiotics and topical corticosteroids. Physical examination revealed an erythematous, pinpoint orifice on his glans penis, with peripheral telangiectasias and a linear bluish structure on dermoscopy (Figure, A and B). Ultrasonography revealed a hypoechoic focal zone on the right side of the glans, with multiple hyperechoic bilaminar structures (Figure, C). A biopsy was performed (Figure, D).

A. Pilonidal sinus

Surgical incision revealed multiple protruding hairs. The lesion was excised and sent for histopathological analysis, which revealed a sinus tract in the dermis lined by stratified epithelium and filled with hair shafts, surrounded by a lymphoplasmacytic inflammatory infiltrate (Figure, D). The wound healed by secondary intention, and the patient had a successful recovery with no signs of recurrence at 6-month follow-up.

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Article Information

Corresponding Author: Catalina Hasbún Zegpi, MD, Department of Dermatology, Faculty of Medicine, Universidad de los Andes, Avenida Plaza 2501, Las Condes, Santiago, Chile (cphasbun@miuandes.cl).

Published Online: March 29, 2023. doi:10.1001/jamadermatol.2023.0142

Conflict of Interest Disclosures: Dr Wortsman reported receiving speaker fees from AbbVie and royalties from Springer Publishing outside the submitted work. No other disclosures were reported.

Additional Contributions: We thank the patient for granting permission to publish the case. We also thank Ivo Sazunic, MD, Laboratorio Histodiagnóstico Málaga, Santiago, Chile, for the histopathological analysis and images, Chris Bunker, MD, Department of Dermatology, University College London Hospitals, London, United Kingdom, for his help in drafting the manuscript. They received no compensation for their contributions to this work.

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.