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Dermatology > BENIGN NEOPLASMS
Fibrous Papule of the Face
Article Last Updated: Jan 24, 2007
AUTHOR AND EDITOR INFORMATION
Section 1 of 10  
Author: Simone Laube, MD, MRCP, Consulting Staff, Skin Centre, City Hospital, Birmingham, United Kingdom
Simone Laube is a member of the following medical societies: Royal College of Physicians of the United Kingdom
Editors: James Fulton Jr, MD, PhD, Medical Director, Fulton Skin Institute; Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center; Jeffrey Meffert, MD, Assistant Clinical Professor of Dermatology, University of Texas Health Science Center-San Antonio; Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University; Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Author and Editor Disclosure
Synonyms and related keywords:
nevus, nevi, nodule, benign skin tumour, reactive nodular hyperplasia, giant cell fibroma
Background
Fibrous papule of the face is a benign, clinically indistinct papule, which has a characteristic histological appearance.
Pathophysiology
Although Helwig originally suggested that fibrous papule was derived from preexisting or involuting melanocytic nevi, immunostaining has refuted this and has confirmed a relationship to factor XIIIa–positive dermal dendrocytes. They are best considered a variant of solitary angiofibroma.
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 papule of the face usually occurs as single lesion, but, occasionally, several lesions may be present (see Image 1).
- Most lesions are located on the nose and, less commonly, on the cheeks, chin, neck, and, rarely, on the lip or forehead.
- 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.
- 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.
Nevi, Melanocytic
Other Problems to be Considered
Clinical differentials
Adnexal tumor
Angioma
Melanocytic nevus
Pyogenic granuloma
Small basal cell carcinoma
Histologic differentials
Facial lesion of adenoma sebaceum
Fibrous variant of rhinophyma
Oral giant cell fibroma
Perifollicular fibroma
Solitary hamartoma
Histologic Findings
Most fibrous papules are characterized by a proliferation of fibroblasts, 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(see Image 2). Elastic tissue may be markedly diminished or entirely absent. Dermal dendritic cells usually stain for factor XIIIa. Several histological subtypes have been described, which might cause diagnostic difficulties. Hypercellular fibrous papules are characterized by a dense infiltrate of round fibroblasts, often with a nevoid appearance (differential diagnoses include malignant melanoma and atypical fibroxanthoma). Clear cell fibrous papules show a proliferation of round clear cells, some with cytoplasm ranging form finely granular to foamy, resembling histiocytes or clear epithelial cells; differential diagnoses include clear cell neoplasm and metastasis (Lee, 2005). Pleomorphic fibrous papules are characterized by bizarre, stellate fibroblasts (differential diagnosis includes pleomorphic fibroma). Pigmented fibrous papules demonstrate prominent melanocytic hyperplasia and dermal macrophages (differential diagnoses include nevus and melanoma). Inflammatory fibrous papules have dense, diffuse dermal infiltrates of predominantly mixed small and large lymphocytes with plasma cells, histiocytes, and rare eosinophils and neutrophils (differential diagnoses include lymphoma, lymphocytic infiltrate, and an infectious process).
Surgical Care
The lesion is benign, but 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.
Patient Education
- The patient should be reassured that the lesion is harmless.
Patients should be made aware that a surgical procedure will result in a scar.
The authors and editors of eMedicine gratefully acknowledge the contributions of previous coauthor Ravi Ratnavel, MD, to the development and writing of this article.
| Media file 1:
Fibrous papule of the nose. Courtesy of San Antonio Uniformed Services Health Education Consortium Dermatology slide files. |
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| Media file 2:
Histopathology of a fibrous papule shows focal fibrosis and vascular proliferation in the upper dermis. Courtesy of Dirk Elston, MD. |
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Fibrous Papule of the Face excerpt Article Last Updated: Jan 24, 2007
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