Piezogenic papules | |
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Other names | Painful fat herniation, piezogenic pedal papules [1] |
Piezogenic papules on the heel of an individual with Ehlers–Danlos syndrome. | |
Specialty | Dermatology |
Symptoms | Multiple yellowish to skin-coloured small or large bumps, mostly painless; typically on heels and wrist [2] [3] |
Causes | Pressure [2] |
Risk factors | Obesity, flat feet, athletes, figure skaters, long-distance runners [3] |
Diagnostic method | Appearance [3] |
Differential diagnosis | Juvenile aponeurotic fibroma [3] |
Treatment | None [3] |
Frequency | Common [1] |
Piezogenic papules are protrusions of fat that form within the subcutaneous tissue of the skin. [1] They are typically found on the heels or wrists.
They present as multiple small or large bumps characteristically on the heels and wrists. [2] Most are asymptomatic and pain is rare, although some may present with pain before the bumps are noticed. [3] They generally occur bilaterally and display a yellowish to skin-color. [3] They may feel soft or firm. [3] [4]
The bumps are caused by pressure. [1] There may be an association with Prader–Willi syndrome, and around a third of individuals with Ehlers–Danlos syndrome may have them. [2] Risk factors include obesity, flat feet, athletics, figure skating, and long-distance running. [3]
Diagnosis is by its appearance. [3] If present in a child it may appear similar to juvenile aponeurotic fibroma. [3]
Generally, no treatment is required. [3] They usually disappear when pressure is relieved; avoidance of prolonged standing, taping foot, compression stockings, heel cups, padding devices. [1]
Piezogenic papules are relatively common; in one small population-based study, the prevalence was found to be 76%. [1] The same study found that it was not unusual to demonstrate the bumps when pressing a person's wrist. [1]
The term was first coined by W. B. Shelley and Rawnsley, who first described them in 1968. [5] [6]