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.