Piezogenic papules

Piezogenic papules are protrusions of fat just beneath skin.[1]

Piezogenic papules
Other namesPainful 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]

Signs and symptoms

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]

Cause and risks

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]

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 usually disappear when pressure is relieved; avoidance of prolonged standing, taping foot, compression stockings, heel cups, 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 was first coined by W. B. Shelley and Rawnsley, who first described them in 1968.[5][6]

See also

References
  1. 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. 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. 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. "Piezogenic papules images | DermNet". dermnetnz.org. Archived from the original on 2 October 2022. Retrieved 28 February 2023.
  5. 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.
  6. Shelley, W. B.; Rawnsley, H. M. (29 July 1968). "Painful feet due to herniation of fat". JAMA. 205 (5): 308–309. doi:10.1001/jama.1968.03140310066020. ISSN 0098-7484. PMID 5694945.
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