Fibrous Papule of the Face

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Background

Fibrous papule of the face is a benign, clinically indistinct papule, also known as sporadic angiofibroma. 

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]

A recent study showed expression of antibodies against p-mTOR in dermal stromal cells and epidermal keratinocytes in fibrous papules, similar to tuberous-sclerosis complex–associated facial angiofibromas, suggesting topical rapamycin may be a treatment option.[2]  

Epidemiology

Frequency

The condition is relatively common.

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 a single lesion, but, occasionally, several lesions may be present. A case of 68-year-old healthy woman with multiple, approximately 100-150, fibrous papules on the face with no apparent underlying genodermatosis or endocrine disorder has been reported.[3]

 



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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. Laser treatment with pulsed dye laser, CO2 laser, and KTP laser has been successfully used for the treatment of angiofibromas such as tuberous sclerosis.

 

Further Outpatient Care

Follow-up care is not required.

Prognosis

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.

Patient Education

The patient should be reassured that the lesion is harmless. Patients should also be made aware that a surgical procedure results in a scar.

Author

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

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Galderma.

Specialty Editors

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

Disclosure: Nothing to disclose.

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

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Disclosure: Nothing to disclose.

Acknowledgements

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

  1. Nemeth AJ, Penneys NS, Bernstein HB. Fibrous papule: a tumor of fibrohistiocytic cells that contain factor XIIIa. J Am Acad Dermatol. 1988 Dec. 19(6):1102-6. [View Abstract]
  2. Chan JY, Wang KH, Fang CL, Chen WY. Fibrous papule of the face, similar to tuberous sclerosis complex-associated angiofibroma, shows activation of the mammalian target of rapamycin pathway: evidence for a novel therapeutic strategy?. PLoS One. 2014. 9 (2):e89467. [View Abstract]
  3. Elifritz J, Krishnan RS, Donnelly H. Numerous fibrous papules of the face unassociated with any genodermatosis. Dermatol Online J. 2007 Oct 13. 13 (4):12. [View Abstract]
  4. Tope WD, Sangueza OP. Rhinophyma's fibrous variant. Histopathology and immunohistochemistry. Am J Dermatopathol. 1994 Jun. 16(3):307-10. [View Abstract]
  5. Odell EW, Lock C, Lombardi TL. Phenotypic characterisation of stellate and giant cells in giant cell fibroma by immunocytochemistry. J Oral Pathol Med. 1994 Jul. 23(6):284-7. [View Abstract]
  6. Kucher C, McNiff JM. Epithelioid fibrous papule - a new variant. J Cutan Pathol. 2007 Jul. 34(7):571-5. [View Abstract]
  7. Lee AN, Stein SL, Cohen LM. Clear cell fibrous papule with NKI/C3 expression: clinical and histologic features in six cases. Am J Dermatopathol. 2005 Aug. 27(4):296-300. [View Abstract]
  8. Park HS, Cho S, Kim KH, Won CH. Fibrous papule of the face, clear cell type: a case report. J Eur Acad Dermatol Venereol. 2007 Oct. 21(9):1267-8. [View Abstract]

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.