Everything you need to know about fibrous papules.

Fibrous Papules: What are we talking about?

Often located on the nose, fibrous papules are small hard bumps typically measuring a few millimetres and taking on a flesh, pinkish or slightly brown colour. Their firm texture is due to an increased density of collagen fibres. Even though they are common, they are frequently mistaken for benign or malignant lesions, particularly for naevi or basal cell carcinomas. Fibrous papules often appear in isolation or in small groups. The face is the most common location, particularly the nasolabial fold, but they can also form on other parts of the body.

A study involving 283 individuals with fibrous papules found that, for 237 of them (83.7%), the lesion was located on the nose.

From a histological perspective, fibrous papules occupy the superficial and middle dermis. They are notably characterised by the proliferation of cells expressing factor XIIIa, a proenzyme of blood coagulation that branches fibrin, arranged within a more or less thick collagen network where numerous dilated blood vessels course. Fibrous papules are the result of a fibroblastic hyperplasia, that is, a proliferation of fibroblasts accompanied by an increase in the extracellular matrix. It should be noted that these histological characteristics define the so-called classic form of fibrous papule. There are variants, such as the granular cell form, clear cell form, epithelioid cell form, as well as the hypercellular, inflammatory, pigmented, and finally the pleomorphic cell form.

What are the causes of the appearance of fibrous papules?

The origin of fibrous papules has not yet been fully elucidated, even though certain factors, presented below, are suspected to be associated with their emergence.

Fibrous papules could have a genetic cause.
It is generally assumed that the emergence of fibrous papules is facilitated by a hereditary susceptibility, with a tendency to develop these bumps in a familial manner. A family history of fibrous papules could thus increase the likelihood of their occurrence, although the genes involved have not yet been identified.
Certain hormonal factors could be implicated in fibrous papules.
A hormonal component could potentially play a role in the development of fibrous papules as periods of hormonal changes, such as puberty, pregnancy, or menopause, can alter the proliferation of fibroblasts. Indeed, an increased production of certain hormones, such as androgens, impacts the proliferation and activity of fibroblasts, thereby influencing collagen production and potentially leading to fibroblastic hyperplasia, one of the characteristics of fibrous papules.
Ageing could potentially play a role in the emergence of fibrous papules.
As the skin ages, its structure changes. Notably, a decrease in collagen production, accompanied by a degradation of the extracellular matrix, can be observed. The skin can then become more prone to hypertrophy of fibrous tissues, which can manifest as benign growths. Thus, the alteration of the fibroblast structure related to skin ageing could in some cases contribute to the appearance of fibrous papules.
The repetition of microtraumas could potentially influence fibrous papules.
Although fibrous papules are not directly caused by blows, repeated microtraumas to the skin could promote their formation. Indeed, even if they do not seem significant, microtraumas such as shocks trigger a local inflammatory response and the release of cytokines and growth factors that enhance the proliferation of fibroblasts. When this stimulation is repeated, it creates an environment conducive to fibroblastic hyperplasia, and therefore to the appearance of fibrous papules.

How to make a fibrous papule disappear?

The fibrous papules do not require treatment as they are benign. However, for aesthetic reasons, it is entirely legitimate to wish to remove them.

Solution No. 1 : The CO2 laser.
The CO2 laser is one of the most commonly used methods for eliminating fibrous papules. It emits at a wavelength of approximately 10.6 micrometres in the infrared, which allows it to target the water contained in the superficial skin cells, causing their vaporisation. This type of laser allows for great precision, making it a preferred option for small facial lesions. Moreover, it offers rapid healing and limited, quickly disappearing side effects, such as redness.
Solution No. 2 : Cryotherapy.
Fibrous papules can also be treated with cryotherapy. This technique involves freezing the papule using liquid nitrogen, which results in the destruction of fibroblastic cells. Cryotherapy is generally less common than CO2 laser for fibrous papules as it carries a higher risk of scarring. However, it remains an interesting option in certain situations.
Solution No. 3 : Electrocoagulation.
Another option for fibrous papules is electrocoagulation. This method involves applying a low-intensity electric current to the base of the papule to destroy the fibrous tissue. It is often used for small spots and it allows for the cauterisation of blood vessels, which limits bleeding and facilitates healing. Redness and scabs may form after the electrocoagulation session, but they usually disappear quickly.
Solution No. 4 : Surgical Excision.
Finally, in the case of fibrous papules, it is possible to perform an outpatient surgical excision under local anaesthesia. For this, the dermatologist uses a scalpel to remove the papule in its entirety, including the fibroblastic base, in order to minimise the risk of recurrence. This method allows for the complete removal of the lesion, although the formation of a small scar is possible. A surgical excision is generally preferred when the fibrous papule is large.

Note : The cosmetic actives commonly used in the case of papules, such as tea tree essential oil or bakuchiol, have not been studied on fibrous papules. Therefore, we cannot predict their effectiveness in this case.