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.
| Piezogenic papules | |
|---|---|
| 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] |
Signs and symptoms
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]
Cause and risks
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
Diagnosis is by its appearance.[3] If present in a child it may appear similar to juvenile aponeurotic fibroma.[3]
Treatment
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]
Epidemiology
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]
History
The term was first coined by W. B. Shelley and Rawnsley, who first described them in 1968.[5][6]