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Fibrous papule of nose
Other Resources UpToDate PubMed

Fibrous papule of nose

Contributors: Rajini Murthy MD, Erik Domingues MD, Nikki Levin MD, Belinda Tan MD, PhD, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

Cutaneous angiofibroma is a term encompassing a range of skin lesions, including angiofibromas or "adenoma sebaceum" of tuberous sclerosis (TS) or multiple endocrine neoplasia type 1, fibrous papules of the face, pearly penile papules, and acral fibrokeratomas.

Fibrous papules of the face (also known as fibrous papules of the nose) are common, small, benign, flesh-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.

Codes

ICD10CM:
D22.39 – Melanocytic nevi of other parts of face

SNOMEDCT:
254745007 – Fibrous papule of nose

Look For

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Diagnostic Pearls

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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, flesh-colored papule; usually present for many years without associated changes.
  • Sebaceous hyperplasia – Presents as a flesh-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 flesh-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.

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed:10/15/2020
Last Updated:10/25/2020
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Fibrous papule of nose
Fibrous papule of nose : Nose, Smooth papule, Tiny papule
Clinical image of Fibrous papule of nose
A small, smooth, well-demarcated, reddish papule on the nose. Note other similar flesh-colored papules in the vicinity (more fibrous papules).
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