Piezogenic papules

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]

See also

• List of cutaneous conditions