How to treat a fibrous papule?

Most commonly, fibrous papules are treated using a CO2 laser. This emits high-intensity infrared light that specifically targets the water present in the superficial skin cells. By heating this water, the laser causes a controlled vaporisation of the affected tissues, without altering the neighbouring cells. The thermal energy not only eliminates the lesion but also stimulates the coagulation of blood vessels, which limits bleeding and promotes healing. The CO2 laser is considered a very precise and minimally invasive technique, interesting for small fibrous papules.

A study conducted on 10 volunteers with fibrous papules demonstrated the effectiveness of this technique. After one to six sessions of CO2 laser treatment, spaced a few weeks apart, 9 out of 10 patients observed a complete disappearance of their fibrous papules. However, it is important to note that half of them saw their fibrous papule replaced by a slight hypertrophic scar, which completely disappeared in only 2 individuals. Despite this, 9 volunteers rated themselves as "satisfied to very satisfied" with the CO2 laser treatment.

Following a CO2 laser session, it is common to observe a slight redness and swelling around the treated area, but these usually disappear within a few days. It is also possible to see thin crusts forming during the healing phase, before falling off after about a week. It should be noted that it is important to use sun protection in the following weeks. The CO2 laser indeed makes the skin more sensitive to UV rays and, without protection, it could develop hyperpigmentation.

Note : CO2 laser sessions are generally not recommended for pregnant or breastfeeding women and individuals undergoing photosensitising treatment, as a precautionary principle.

Fibrous papules can also be removed by cryotherapy, a method that relies on the application of intense cold to destroy unwanted tissues through rapid freezing. The principle of cryotherapy is to create a thermal shock. Indeed, the contact of the cryogen, such as liquid nitrogen, with the skin, freezes the water contained in the cells of the fibrous papule, forming intracellular ice crystals. These crystals cause mechanical damage and disrupt the cellular membrane, leading to the destruction of the cells. The intense cold also causes an initial constriction of the blood vessels, followed by vasodilation as the temperature returns to physiological levels, contributing to tissue repair.

The freezing of the fibrous papule results in its temporary hardening and the emergence of slight redness and swelling around it. A crust then forms in the days following cryotherapy, before falling off spontaneously. This is similar to the CO2 laser, the use of a sunscreen in the following weeks is necessary to protect the skin weakened by cryotherapy. It should be noted that this method is less common in the case of a fibrous papule as it carries a greater risk of scarring than the CO2 laser.

Note : Cryotherapy is not recommended for pregnant women or individuals suffering from certain severe cardiovascular or respiratory diseases.

Electrocoagulation is also a viable option for treating a fibrous papule. This method relies on the use of high-frequency electric current to heat and destroy the excess tissue of the papule. The aim of electrocoagulation is to induce a localised coagulation of the papule's cells, leading to their necrosis and gradual disappearance. Indeed, the electric current is not limited to the epidermis, but can also penetrate the deeper layers of the skin to reach the entirety of the fibrous papule. Electrocoagulation allows for the removal of the blemish but is precise enough to preserve the surrounding skin structures.

Another advantage of electrocoagulation is its haemostatic effect: the electric current immediately cauterises small blood vessels, which limits bleeding during and after the procedure. After an electrocoagulation session, the fibrous papule darkens slightly and forms a crust in the following days. Depending on the depth and size of the papule, one or more sessions may be necessary to achieve its complete disappearance. Once again, a strict sun protection is recommended after the procedure

Note : Electrocoagulation is contraindicated for pregnant women, haemophiliacs, those suffering from certain heart diseases, as well as individuals with a pacemaker.

In the case of large fibrous papules, surgical excision is generally preferred. As the name suggests, this technique involves removing the fibrous papule using surgical instruments for a complete and direct elimination of the tissue. Once the area is anaesthetised, the surgeon uses a scalpel or a surgical knife to incise the skin around the fibrous papule and remove the excess fibrous tissue. Unlike other less invasive methods, surgical excision ensures that the entire papule, including its dermal base, is removed. If the wound is significant, it can then be sutured.

It is crucial to maintain good hygiene following the procedure, in order to prevent any infection and promote a swift healing process. The surgeon typically prescribes antiseptic and healing ointments for the initial days post-excision. To minimise the risk of scarring and hyperpigmentation, it is also advised not to expose the area to the sun during the healing phase and to diligently use sun protection if it cannot be covered. Lastly, in the event of blood discharge, abnormal sensitivity or persistent redness after the excision, it is important for the patient to get back in touch with their doctor.

Before opting for any of the methods mentioned above, we recommend you to seek advice from your dermatologist, so they can guide you towards the treatment most suited to your circumstances.

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• WALKER N. & al. Carbon dioxide and pulsed dye laser treatment of angiofibromas in 29 patients with tuberous sclerosis. British Journal of Dermatology (2002).

• USATINE R. & al. Electrosurgery for the Skin. American Family Physician (2002).

• ANDREWS M. & al. Cryosurgery for Common Skin Conditions. American Family Physician (2004).

• COCKERELL C. & al. Histologic Variants of Fibrous Papule. Journal of Cutaneous Pathology (2008).

• BISWAS A. & al. Fibrous Papule: A Histopathologic Review. The American Journal of dermatopathology (2018).