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Fibrous papule of nose - Skin
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Fibrous papule of nose - Skin

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Contributors: Erik Domingues MD, Nikki Levin MD, Jeffrey D. Bernhard MD, Belinda Tan MD, PhD, Noah Craft MD, PhD, Lindy P. Fox MD, Lowell A. Goldsmith MD, MPH, Michael D. Tharp MD
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Synopsis

Fibrous papules of the nose, fibrous papules of the face, perifollicular fibromas, and angiofibromata are common small, benign, flesh-colored papules located on the nose or central face. They are typically asymptomatic, although they may bleed with trauma. Fibrous papules of the nose may present a diagnostic dilemma in that they can be difficult to distinguish from other small papular lesions of the central face including basal cell carcinoma, nevi, and sebaceous hyperplasia.

Their exact etiology is unknown, but some have suggested that fibrous papules represent nevi that no longer synthesize S-100 protein. However, 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. The papules typically occur in middle age.

Patients with multiple fibrous papules should be examined for other signs of systemic diseases including tuberous sclerosis, neurofibromatosis type 2, multiple endocrine neoplasia type 1, and Hornstein-Knickenberg syndrome.

Pediatric Patient Considerations:
Tuberous sclerosis should be considered in children with multiple fibrous papules. Inquire about medical and family history including seizures, mental impairment or developmental delay, behavioral disorders, visual problems, and tumors of the brain, heart, kidneys, lungs, and skin.

Codes

ICD10CM:
D23.39 – Other benign neoplasm of skin 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.
  • Adnexal tumor – May present as a nonspecific flesh-colored papule.

Best Tests

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Management Pearls

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Therapy

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References

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Last Updated: 10/27/2017
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Fibrous papule of nose - Skin
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Fibrous papule of nose : Cheek, Chin, 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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