First case of penile porokeratosis from Nepal: a case report.

Introduction and importance: Porokeratosis is a rare keratinization disorder marked by atrophic patches with a distinct hyperkeratotic border known as a cornoid lamella. Genital porokeratosis (GP), especially involving the penis, is extremely uncommon, with only a handful of cases reported worldwide. This case report describes the first instance of penile porokeratosis from Nepal, highlighting its rarity and clinical presentation. Case presentation: A 22-year-old male presented with a 3 × 3 cm annular plaque on the shaft of his penis, which had been asymptomatic for a year. Histopathology confirmed the diagnosis of porokeratosis, and tests for sexually transmitted infections were negative. Following a single session of cryotherapy, the patient was counseled about the benign nature of the lesion. Regular follow-ups were scheduled every 4 weeks for additional cryotherapy and to monitor for any potential malignant change. Discussion: GP is a rare condition, potentially triggered by environmental factors like heat and friction. Diagnosis can be challenging due to its similarity to other dermatoses, making histopathology essential. Although other forms of porokeratosis carry a risk of malignancy, there are no known cases of GP progressing to cancer. Conclusion: Penile porokeratosis should be considered in the differential diagnosis of persistent genital lesions. A biopsy is crucial for accurate diagnosis, as misdiagnosis can delay appropriate treatment. Further studies are needed to better understand this rare disease, including its incidence, pathophysiology, and risk of malignant transformation.