Piezogenic papules are fairly common nodular lesions, primarily affecting the feet, although they can also be found on the hands. Depending on their location, piezogenic papules can be bothersome and affect walking. Discover here how to treat them.
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How to treat piezogenic papules?
Summary
Published October 29, 2024,
updated on October 29, 2024,
by
Pauline, Head of Scientific Communication
—
5 min read
Piezogenic Papules: What are we talking about?
First described in 1968, piezogenic papules are small skin protrusions that typically appear on the heels or the lateral part of the feet. These papules are soft to the touch, rounded or slightly oval in shape, and their size often varies from a few millimetres to one centimetre in diameter. Unlike other types of spots, they are asymptomatic in 90% of cases and are generally reversible, often disappearing spontaneously with rest. Furthermore, piezogenic papules show no signs of infection.
Piezogenic papules are caused by a swelling of the subcutaneous fat through the fascia, a connective tissue membrane that wraps around the muscles and keeps fatty tissues in place. Under the effect of prolonged pressure or repeated mechanical stress, the adipose tissue of the heels can penetrate this protective barrier and form these small bumps visible under the skin. This phenomenon mainly occurs in people who spend long hours standing, athletes or individuals suffering from obesity, conditions that promote increased pressure on the heels.
Note : Less commonly, pearly papules may be due to genetic disorders, such as Prader-Willi syndrome, a rare disease notably characterised by severe muscle hypotonia and a growth disorder.
How to manage piezogenic papules?
In the event of persistent or bothersome piezogenic papules, several therapeutic options are available.
Corticosteroid infiltrations.
Sometimes combined with anaesthetics, corticosteroid injections can reduce discomfort associated with piezogenic papules by lowering the levels of pro-inflammatory cytokines. They are particularly beneficial for individuals whose papules cause chronic pain. However, it is important to note that corticosteroid injections are contraindicated for patients suffering from diabetes, bone disorders such as osteoporosis, or healing problems as corticosteroids can disrupt tissue regeneration.
Electro-acupuncture.
Less invasive, electro-acupuncture is a technique that involves applying fine needles and sending low-intensity electrical impulses to stimulate local circulation. The aim is to reduce tissue congestion and thus alleviate pain and piezogenic papules. Although electro-acupuncture is generally well tolerated, it is not recommended for patients with heart conditions, particularly those with pacemakers, or coagulation disorders, as it can cause haematomas at the needle insertion sites.
The wearing of compression stockings.
When piezogenic papules are associated with venous insufficiency, doctors may prescribe compression stockings. These exert a decreasing pressure, stronger at the ankle and decreasing towards the top of the leg, which promotes venous return by facilitating blood circulation from the feet towards the heart. Moreover, by limiting venous stasis, compression stockings reduce the pressure in the veins of the feet and ankles, which decreases the risks of exacerbating piezogenic papules. However, caution is needed regarding compression stockings: it is important that they are individually adjusted as inappropriate pressure can cause discomfort and worsen circulation problems.
Surgical excision.
If piezogenic papules are symptomatic, surgical excision may be considered. This procedure involves surgically removing the overgrowth of adipose tissue by excising the affected area. The operation requires local anaesthesia and, although it is relatively minimally invasive, it can result in scarring, hyperpigmentation, or post-operative local sensitivity. Its success largely depends on the location of the piezogenic papules and the patient's healing capacity, which can be more delicate in the heel region.
The low-intensity laser.
Finally, low-intensity laser therapy could be a solution for piezogenic papules. This is at least what a study conducted with two volunteers suffering from painful piezogenic papules suggests. After ten sessions of low-intensity laser therapy spread over fifteen days, the scientists observed a disappearance of the patients' papules. Although the small number of participants calls for caution, these results are nonetheless encouraging. If we look at how it works, the low-intensity laser acts by increasing local blood circulation, which reduces oedema. It also stimulates the tissue repair process in cells and decreases pain.
Sources
GERSTEIN W. & al. Painful and Nonpainful Piezogenic Pedal Papules. Archives of Dermatology (1972).
PAVLOVIC M. & al. Painful piezogenic pedal papules - successful low level laser therapy. Acta Dermatoven (2001).
LEONARD J. & al. A Nonsurgical Approach to Painful Piezogenic Pedal Papules. Cutis (2004).
VANO-GALVAN S. & al. Piezogenic pedal papules. Canadian Medical Association Journal (2013).
DE OLIVEIRA PRATES F. & al. Piezogenic Pedal Papules. Anais Brasileiros de Dermatologia (2015).
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