Discussion
Smegma pearls are small, yellowish-white lumps that can develop in the glans of uncircumcised boys due to a buildup of smegma, typically between the preputial membrane and the base of the glans penis.(1) In affected individuals, the prepuce exhibits a partial retractability while the urethra remains unaffected. A diverse range of bacterial species may inhabit the preputial sac, thereby predisposing them to bacterial superinfection.(2) With regard to management, the primary therapeutic modality for smegma pearls involves offering reassurance and counseling to the patient, with the expectation that spontaneous separation will occur over time. However, caution must be exercised while attempting bimanual retraction of smegma, as it carries the potential risk of complications such as paraphimosis, recurrence of phimosis, and the development of additional smegma pearls.
The differential diagnosis of the swelling presenting in the tip of penis usually includes preputial Epstein pearls, preputial cysts, median raphe cysts and smegma stone(smegmaliths). Those various swelling could easily be differentiated based on the location and age of the child. Preputial Epstein pearls are usually pearly white swelling present over the tip of penis incidentally found in male newborn and disappear by seventh day of life. (3) Preputial cysts are the nodular swelling present under the glans and median raphe cysts are located over the ventral surface of the penis due to tissue trapping during development of the urethral folds. Smegma stones presents in adult men with inflamed and partially retractable prepuce with sub preputial discharge.
Although smegma pearl is best managed conservatively, some physicians advise for 6 to 8 weeks of low potency steroids. (1) In this particular case, the mother harbored apprehensions and reservations regarding the natural course of the condition, and therefore we opted for manual extraction in consultation with a urologist. While it may be argued that such intervention was unnecessary from a clinical standpoint, it was deemed necessary on social grounds to assuage the concerns of the mother.