White Nodules on a Baby's Penis
White nodules on a baby's penis are almost always benign smegma pearls—collections of normal desquamated epithelial cells, fat, and protein under the foreskin that require only parental reassurance and observation, as they spontaneously resolve over time without intervention. 1, 2
What Are Smegma Pearls?
- Smegma pearls appear as yellowish-white lumps or nodules visible through or under the penile foreskin in uncircumcised infant boys 1, 2
- They consist of normal smegma (desquamated epithelial cells, fat, and protein) that accumulates as the foreskin naturally separates from the glans epithelium during normal development 1
- This is a physiologic process—smegma production and cell keratinization actually facilitate the normal separation of the fused foreskin from the glans 1
- Smegma itself is neither damaging, irritating, nor carcinogenic 1
Clinical Presentation
- Presents as painless, white to yellowish nodules on the penile shaft or under the foreskin 1, 2
- No associated pain, bleeding, discharge, or other symptoms 1
- The yellowish color comes from the smegma content itself 1
- Parents often present with significant anxiety about these lesions, though they are completely benign 2
Management Approach
The only treatment needed is parental reassurance and watchful waiting:
- Smegma pearls are benign and spontaneously resolve over time without any intervention 1, 2
- No investigations, referrals, or treatments are necessary 1, 2
- Monitoring for resolution is appropriate, but active intervention is not indicated 1
Important Distinctions
While smegma pearls are by far the most common cause of white penile nodules in infants, be aware of these rare alternatives:
- Smegma cysts: When smegma becomes enclosed in a well-formed epithelial wall (still benign) 1
- Smegmoliths: Long-standing smegma that hardens into stone-like structures due to chronic irritation and mineral accumulation (rare) 1
- Lichen sclerosus (balanitis xerotica obliterans): Characterized by white scarred areas on the glans or prepuce, associated with pathological phimosis—this requires specialist referral 3
Key Clinical Pitfall
The main pitfall is misdiagnosing smegma pearls as pathologic lesions, leading to unnecessary anxiety, investigations, and specialist referrals 1, 2. Despite being common in uncircumcised young boys, smegma pearls are underreported in medical literature, contributing to diagnostic confusion among pediatricians unfamiliar with the condition 1.
When to Consider Other Diagnoses
Refer to pediatric urology or pediatric surgery if you observe: