Most cases of fibrous papule are benign and clinically indistinguishable papule characterized histological appearance. The lesion’s pathogenesis and nature remain controversial.

Features of most fibrous papules include a fibrotic stroma, dilated blood vessels and proliferation of fibroblasts. Sometimes, there is the presence of a sparse inflammatory cell that infiltrates the lymphocytes. In its basal layer, there is accumulation of large polygonal melanocytes and Acanthosis. There may be several factors which make diagnosis difficult for fibrous papules.

Papules with fibrous clear cell indicate a propagation of clear round cells. Some of them contain a little amount of foamy cytoplasm, similar to clear epithelial cells or histiocytes.

Pleomorphic fibrous papules on the other hand, are distinguished by bizarre, stellate fibroblasts.

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Signs and Symptoms

• Papules are usually 1-5 mm in diameter and are barely visible in some cases.

• Their distinct characteristics apart from other skin lesions include being firm and indurated.

• Fibrous papules may either be located at localized areas of the face or of the whole. It occurs usually on the cheeks, chin, lip, neck, and forehead.

• Papules that may be present on the fingers also resemble that of giant cell fibroma or reactive nodular hyperplasia.

• They may form several clusters with a number of lesions grouped together of individual papules at several parts of the body.

• Fibrous papules usually appear in shiny skin-colored and dome-shaped lesions.

Treatment

Good news is that pustules are benign lesions. It may be removed surgically to confirm the diagnosis or for other cosmetic reasons. Surgeons may result to procedures such as elliptical excision, curettage, or shave excision.