Piezogenic papules

Piezogenic papules
Other names: Painful fat herniation, piezogenic pedal papules[1]
Piezogenic papules on the heel of an individual with Ehlers–Danlos syndrome.
SpecialtyDermatology
SymptomsMultiple yellowish to skin-coloured small or large bumps, mostly painless; typically on heels and wrist[2][3]
CausesPressure[2]
Risk factorsObesity, flat feet, athletes, figure skaters, long-distance runners[3]
Diagnostic methodAppearance[3]
Differential diagnosisJuvenile aponeurotic fibroma[3]
TreatmentNone[3]
FrequencyCommon[1]

Piezogenic papules are protrusions of fat just beneath skin.[1] They present as multiple small or large bumps characteristically on the heels and wrists.[2] Most are asymptomatic and pain is rare, although some may present with pain before the bumps are noticed.[3] They generally occur bilaterally and display a yellowish to skin-color.[3] They may feel soft or firm.[3][4]

The bumps are caused by pressure.[1] There may be an association with Prader–Willi syndrome, and around a third of individuals with Ehlers–Danlos syndrome may have them.[2] Risk factors include obesity, flat feet, athletics, figure skating, and long-distance running.[3] If present in a child it may appear similar to juvenile aponeurotic fibroma.[3] Generally, no treatment is required.[3] They usually disappear when pressure is relieved; avoidance of prolonged standing, taping foot, compression stockings, heel cups, padding devices.[1]

Piezogenic papules are common.[1] The term was first coined by Shelley and Rawnsley, who first described them in 1968.[5]

Signs and symptoms

Piezogenic papules present as multiple small or large bumps characteristically on the heels and wrists.[2] Most are asymptomatic and pain is rare, although some may present with pain before the bumps are noticed.[3] They generally occur bilaterally and display a yellowish to skin-color.[3] They may feel soft or firm.[3][4]

  • Piezogenic papules
    Piezogenic papules
  • Piezogenic papules (heel)
    Piezogenic papules (heel)
  • Piezogenic papules (heel)
    Piezogenic papules (heel)
  • Piezogenic papules (heel)
    Piezogenic papules (heel)
  • Piezogenic papules (heel)
    Piezogenic papules (heel)
  • Piezogenic papules (wrist)
    Piezogenic papules (wrist)

Cause and risks

The bumps are caused by pressure.[1] They occur more frequently in runners, athletes, and individuals exposed to long periods of standing.[3] There may be an association with Prader–Willi syndrome, and around a third of individuals with Ehlers–Danlos syndrome may have them.[2]

Risk factors include obesity, flat feet, athletics, figure skating, and long-distance running.[3]

Diagnosis

Diagnosis is by its appearance.[3] If present in a child it may appear similar to juvenile aponeurotic fibroma.[3]

Treatment

Generally, no treatment is required.[3] They typically disappear when pressure is relieved.[1] Management includes avoidance of prolonged standing, and may require using foot tape, compression stockings, heel cups, or padding devices.[1]

Epidemiology

Piezogenic papules are relatively common; in one small population-based study, the prevalence was found to be 76%.[1] The same study found that it was not unusual to demonstrate the bumps when pressing a person's wrist.[1]

History

The term 'piezogenic papule' was first coined by W. B. Shelley and Rawnsley, who first described them in 1968.[5][6]

See also

References

  1. 1 2 3 4 5 6 7 8 9 10 11 James, William D.; Elston, Dirk; Treat, James R.; Rosenbach, Misha A.; Neuhaus, Isaac (2020). "3. Dermatoses resulting from physical factors". Andrews' Diseases of the Skin: Clinical Dermatology (13th ed.). Edinburgh: Elsevier. p. 40. ISBN 978-0-323-54753-6. Archived from the original on 2023-02-26. Retrieved 2023-02-26.
  2. 1 2 3 4 5 6 Johnstone, Ronald B. (2017). "35. Tumors of fat". Weedon's Skin Pathology Essentials (2nd ed.). Elsevier. p. 641. ISBN 978-0-7020-6830-0. Archived from the original on 2023-02-26. Retrieved 2023-02-26.
  3. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Brown, Falon; Cook, Christopher (2022). "Piezogenic Pedal Papule". StatPearls. StatPearls Publishing. PMID 29489228. Archived from the original on 2022-01-14. Retrieved 2023-02-26.
  4. 1 2 "Piezogenic papules images | DermNet". dermnetnz.org. Archived from the original on 2 October 2022. Retrieved 28 February 2023.
  5. 1 2 Elder, David E.; Elenitsas, Rosalie; Murphy, George F.; Rosenbach, Misha; Rubin, Adam I.; Seykora, John T.; Xu, Xiaowei (2023). Lever's Dermatopathology: Histopathology of the Skin. Lippincott Williams & Wilkins. p. 3254. ISBN 978-1-9751-7449-1. Archived from the original on 2023-02-28. Retrieved 2023-02-28.
  6. ↑ Shelley, W. B.; Rawnsley, H. M. (29 July 1968). "Painful feet due to herniation of fat". JAMA. 205 (5): 308–309. ISSN 0098-7484. PMID 5694945. Archived from the original on 5 March 2022. Retrieved 28 February 2023.
External resources


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