Piezogenic papules

Author: Dr Peggy Chen MB ChB, Dermatology Registrar, Waikato Hospital, Hamilton, New Zealand, 2013.


What are piezogenic papules?

Piezogenic papules are common, soft, skin-coloured papules found on the feet and wrists. They result from herniation of fat through the dermis. The name "piezogenic" refers to the origin of the papules being pressure.

Who gets piezogenic papules?

People of all ages, gender and ethnicities are susceptible to piezogenic papules. They are commonly observed in overweight or obese women. They are also associated with underlying connective tissue diseases such as Ehlers-Danlos syndrome, flat feet, and excessive weight-bearing exercise.

Piezogenic papules are of unknown cause.

Clinical features of piezogenic papules

Piezogenic papules are mostly asymptomatic and are noticed incidentally. Occasionally they may be painful.

Piezogenic papules

See more images of piezogenic papules ...

How is the diagnosis made?

Piezogenic papules are usually diagnosed clinically because of the following features:

  • Papules resolve when the patient is non-weight bearing
  • Papules can usually be compressed
  • They mostly occur over posterior and lateral border of the heels
  • They are often bilateral

What is the treatment for piezogenic papules?

No treatment is required in the absence of symptoms.

For painful lesions, a number of conservative managements have been documented.

  • Restriction of weight-bearing exercise
  • Weight loss
  • Compression stockings
  • Foam rubber foot pads, or foam-fitting plastic heel cups
  • A consultation with a podiatrist may be helpful.

Intralesional corticosteroid injections have been documented to provide some relief for patients with piezogenic papules with underlying Ehlers-Danlos syndrome.

Surgical excision may be helpful if symptoms persist despite above managements but this is rarely necessary.

 

Related Information

References:

  • Maari C, Powell J. Atrophies of connective tissue. In Dermatology. Bolognia JL, Jorizzo JL, Schaffer JV. Third edition. Elsevier 2012, p1639.
  • Kahana M, Feinsein A, Tabachnic E, Schewach-Millet M, Engelberg S. Painful piezogenic pedal papules in patients with Ehlers-Danlos syndrome. J Am Acad Dermatol. Aug 1987; 17(2): 205-9. Medline.
  • Laing VB, Fleischer AB Jr. Piezogenic wrist papules: a common and asymptomatic finding. J Am Acad Dermatol. Mar 1991;24(3): 415–7. Medline.

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