Fibrous papule of nose
Fibrous papules of the face (also known as fibrous papules of the nose) are common, small, benign, skin-colored papules located on the nose or central face. Their onset is typically in middle age, and they are usually solitary or few in number. They are typically asymptomatic, although they may bleed with trauma. Their exact etiology is unknown, but some have suggested that fibrous papules represent nevi that no longer synthesize S-100 protein. Other studies involving electron microscopy suggest that they are derived from fibroblasts because premelanosomes and basal lamina are not seen.
There is no known predilection for a particular sex, ethnicity, or socioeconomic status.
D22.39 – Melanocytic nevi of other parts of face
254745007 – Fibrous papule of nose
Differential Diagnosis & Pitfalls
- Basal cell carcinoma – Look for a pearly papule with telangiectasias, erosion, or ulceration. Ask about increases in size, bleeding, or ulceration. Shave biopsy if this is suspected.
- Compound nevus – Presents as a round, skin-colored papule; usually present for many years without associated changes.
- Sebaceous hyperplasia – Presents as a skin-colored to yellow papule with a central pore; frequently located on the forehead.
- Common wart
- Cherry hemangioma – Presents as a cherry red, round papule, usually on the trunk but may occur on the head, neck, and extremities.
- Lobular capillary hemangioma (pyogenic granuloma) – Presents as a fungating mass that bleeds excessively when traumatized; more common in children.
- Angiofibromas – Histologically indistinguishable. Tuberous sclerosis should be considered in children, adolescents, or adults with multiple fibrous papules. Also consider the diagnosis of multiple endocrine neoplasia type 1 in patients with numerous angiofibromas.
- Trichoepithelioma – May present as a skin-colored papule.
- Birt-Hogg-Dubé syndrome – Cutaneous findings include fibrofolliculomas, trichodiscomas, and skin tags. Fibrofolliculomas and trichodiscomas may present as skin-colored or whitish papules on the face, neck, trunk, and extremities.