Fibrous Papule of the Face

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Background

Fibrous papule of the face is a benign, clinically indistinct papule.

Pathophysiology

In the past, fibrous papule has been suggested to have been derived from preexisting or involuting melanocytic nevi; however, subsequent investigations appear to have refuted this and have confirmed a relationship to factor XIIIa – positive dermal dendrocytes. Fibrous papule is best considered a variant of angiofibroma.[1]

Epidemiology

Frequency

International

The condition is relatively common.

Mortality/Morbidity

Fibrous papule of the face is a benign lesion. Most of the lesions are asymptomatic, although one third of patients have reported bleeding following minor trauma.

Race

No racial predilection is known.

Sex

Both sexes are equally affected.

Age

Most of the patients are in their third to fifth decade of life.

History

Family history is not considered relevant.

Physical

The lesions are clinically indistinct. Fibrous papules are usually dome-shaped lesions with a shiny, skin-colored appearance. Occasionally, lesions are sessile, polypoid, or papillomatous. Most of the lesions are firm and indurated. Size usually ranges from 1-5 mm in diameter.

Fibrous papule of the face usually occurs as single lesion, but, occasionally, several lesions may be present.


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Fibrous papule of the nose. Courtesy of San Antonio Uniformed Services Health Education Consortium Dermatology slide files.

Most lesions are located on the nose and, less commonly, on the cheeks, chin, neck, and, rarely, on the lip or forehead. Similar papules may be present on the fingers or oral mucosa, where they have been described as reactive nodular hyperplasia or giant cell fibroma.

Causes

See Pathophysiology.

Histologic Findings

Fibrous papules are characterized by a proliferation of stellate and spindled cells, a fibrotic stroma, and dilated blood vessels. Occasionally, a sparse inflammatory cell infiltrate of lymphocytes is present.

Acanthosis and an increased number of large polygonal melanocytes may be present in the basal layer. Elastic tissue may be markedly diminished or entirely absent.


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Histopathology of a fibrous papule shows focal fibrosis and vascular proliferation in the upper dermis. Courtesy of Dirk Elston, MD.

Dermal dendritic cells usually stain for factor XIIIa.

Several histological subtypes have been described, which might cause diagnostic difficulties.

Surgical Care

The lesion is benign, but it may be removed to confirm the diagnosis or for cosmetic reasons. Surgical procedures include curettage, shave excision, or elliptical excision.

Further Outpatient Care

Follow-up care is not required.

Prognosis

Fibrous papule of the face is a benign lesion.

Author

Simone Laube, MD, MRCP, Consulting Staff, Department of Dermatology, Borders General Hospital, Melrose and Western General Hospital, Edinburgh

Disclosure: Nothing to disclose.

Specialty Editors

James Fulton Jr, MD, PhD, Center for Cosmetic Dermatology; Consultant, Vivant Pharmaceuticals, LLC

Disclosure: Vivant Pharmaceuticals Grant/research funds Consulting

Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Disclosure: Nothing to disclose.

Jeffrey Meffert, MD, Assistant Clinical Professor of Dermatology, University of Texas School of Medicine at San Antonio

Disclosure: Nothing to disclose.

Catherine M Quirk, MD, Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Ackerman Academy of Dermatopathology, New York

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous coauthor Ravi Ratnavel, MD, to the development and writing of this article.

References

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Fibrous papule of the nose. Courtesy of San Antonio Uniformed Services Health Education Consortium Dermatology slide files.

Histopathology of a fibrous papule shows focal fibrosis and vascular proliferation in the upper dermis. Courtesy of Dirk Elston, MD.

Fibrous papule of the nose. Courtesy of San Antonio Uniformed Services Health Education Consortium Dermatology slide files.

Histopathology of a fibrous papule shows focal fibrosis and vascular proliferation in the upper dermis. Courtesy of Dirk Elston, MD.