eMedicine Specialties > Dermatology > Benign Neoplasms

Fibrous Papule of the Face: Differential Diagnoses & Workup

Author: Simone Laube, MD, MRCP, Consulting Staff, Department of Dermatology, Aberdeen Royal Infirmary, UK
Contributor Information and Disclosures

Updated: Feb 26, 2009

Differential Diagnoses

Nevi, Melanocytic

Other Problems to Be Considered

Clinical differentials
Adnexal tumor
Angioma
Melanocytic nevus
Pyogenic granuloma
Small basal cell carcinoma

Histologic differentials
Facial lesion of adenoma sebaceum
Fibrous variant of rhinophyma2
Oral giant cell fibroma3
Perifollicular fibroma
Solitary hamartoma

Workup

Histologic Findings

Fibrous papules are characterized by a proliferation of stellate and spindled cells, a fibrotic stroma, and dilated blood vessels. Occasionally, a sparse inflammatory cell infiltrate of lymphocytes is present.

Acanthosis and an increased number of large polygonal melanocytes may be present in the basal layer. Elastic tissue may be markedly diminished or entirely absent.

Histopathology of a fibrous papule shows focal fi...

Histopathology of a fibrous papule shows focal fibrosis and vascular proliferation in the upper dermis. Courtesy of Dirk Elston, MD.

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Histopathology of a fibrous papule shows focal fi...

Histopathology of a fibrous papule shows focal fibrosis and vascular proliferation in the upper dermis. Courtesy of Dirk Elston, MD.


Dermal dendritic cells usually stain for factor XIIIa.

Several histological subtypes have been described, which might cause diagnostic difficulties.

  • Hypercellular fibrous papule is characterized by an increased number of stellate and spindled cells; differential diagnoses include malignant melanoma and atypical fibroxanthoma.4
  • Clear cell fibrous papule shows a proliferation of round clear cells, some with cytoplasm ranging from finely granular to foamy, resembling histiocytes or clear epithelial cells; differential diagnoses include clear cell neoplasm and metastasis.5 Some authors also differentiate a granular cell fibrous papule, which is similar to the clear cell fibrous papule but seems to contain coarser cytoplasmic granules.6
  • Pleomorphic fibrous papule is characterized by bizarre, stellate fibroblasts; differential diagnosis includes pleomorphic fibroma.
  • Pigmented fibrous papule demonstrates prominent melanocytic hyperplasia and dermal macrophages; differential diagnoses include nevus and melanoma.
  • Inflammatory fibrous papule has dense, diffuse dermal infiltrate of predominantly mixed small and large lymphocytes with plasma cells, histiocytes, and rare eosinophils and neutrophils; differential diagnoses include lymphoma, lymphocytic infiltrate, and an infectious process.
  • More recently, an epithelioid variant has been described.4 Histopathologically, it consists of epithelioid-type cells with pink cytoplasm, medium-sized nuclei, and, sometimes, prominent nucleoli; differential diagnoses include melanoma, intradermal nevus, Spitz nevus, xanthogranuloma, and dermatofibroma.

More on Fibrous Papule of the Face

Overview: Fibrous Papule of the Face
Differential Diagnoses & Workup: Fibrous Papule of the Face
Treatment & Medication: Fibrous Papule of the Face
Follow-up: Fibrous Papule of the Face
Multimedia: Fibrous Papule of the Face
References
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References

  1. Nemeth AJ, Penneys NS, Bernstein HB. Fibrous papule: a tumor of fibrohistiocytic cells that contain factor XIIIa. J Am Acad Dermatol. Dec 1988;19(6):1102-6. [Medline].

  2. Tope WD, Sangueza OP. Rhinophyma's fibrous variant. Histopathology and immunohistochemistry. Am J Dermatopathol. Jun 1994;16(3):307-10. [Medline].

  3. Odell EW, Lock C, Lombardi TL. Phenotypic characterisation of stellate and giant cells in giant cell fibroma by immunocytochemistry. J Oral Pathol Med. Jul 1994;23(6):284-7. [Medline].

  4. Kucher C, McNiff JM. Epithelioid fibrous papule - a new variant. J Cutan Pathol. Jul 2007;34(7):571-5. [Medline].

  5. Lee AN, Stein SL, Cohen LM. Clear cell fibrous papule with NKI/C3 expression: clinical and histologic features in six cases. Am J Dermatopathol. Aug 2005;27(4):296-300. [Medline].

  6. Park HS, Cho S, Kim KH, Won CH. Fibrous papule of the face, clear cell type: a case report. J Eur Acad Dermatol Venereol. Oct 2007;21(9):1267-8. [Medline].

  7. Bansal C, Stewart D, Li A, Cockerell CJ. Histologic variants of fibrous papule. J Cutan Pathol. Jul 2005;32(6):424-8. [Medline].

  8. Calonje E, MacKie RM. Soft-Tissue Tumours and Tumour-like Conditions. In: Burns T, Breathnach S, Cox N, Griffiths C, eds. Rook's Textbook of Dermatology. Vol 3. 7th ed. London, England: Blackwell Science; 2004:53.

  9. Cerio R, Rao BK, Spaull J, Jones EW. An immunohistochemical study of fibrous papule of the nose: 25 cases. J Cutan Pathol. Aug 1989;16(4):194-8. [Medline].

  10. Cintra ML, de Souza EM. Focal acantholytic dyskeratosis: a snare for the pathologist. Report of two cases associated to psoriasis and fibrous papule of the nose. Rev Paul Med. Sep-Oct 1992;110(5):237-40. [Medline].

  11. Fibrous papules and nevocellular nevi. J Am Acad Dermatol. Apr 1984;10(4):670-1. [Medline].

  12. Graham JH, Sanders JB, Johnson WC, Helwig EB. Fibrous papule of the nose: a clinicopathological study. J Invest Dermatol. Sep 1965;45(3):194-203. [Medline].

  13. Guitart J, Bergfeld WF, Tuthill RJ. Fibrous papule of the nose with granular cells: two cases. J Cutan Pathol. Aug 1991;18(4):284-7. [Medline].

  14. Meigel WN, Ackerman AB. Fibrous papule of the face. Am J Dermatopathol. Winter 1979;1(4):329-40. [Medline].

  15. Saylan T, Marks R, Jones EW. Fibrous papule of the nose. Br J Dermatol. Aug 1971;85(2):111-8. [Medline].

  16. Shea CR, Salob S, Reed JA, Lugo J, McNutt NS. CD34-reactive fibrous papule of the nose. J Am Acad Dermatol. Aug 1996;35(2 Pt 2):342-5. [Medline].

  17. Spiegel J, Nadji M, Penneys NS. Fibrous papule: an immunohistochemical study with an antibody to S-100 protein. J Am Acad Dermatol. Sep 1983;9(3):360-2. [Medline].

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Further Reading

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Keywords

fibrous papule of the face, nevus, nevi, nodule, benign skin tumour, reactive nodular hyperplasia, giant cell fibroma

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Contributor Information and Disclosures

Author

Simone Laube, MD, MRCP, Consulting Staff, Department of Dermatology, Aberdeen Royal Infirmary, UK
Simone Laube, MD, MRCP is a member of the following medical societies: British Association of Dermatologists
Disclosure: Nothing to disclose.

Medical Editor

James Fulton Jr, MD, PhD, Medical Director, Fulton Skin Institute
James Fulton Jr, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Cosmetic Surgery, American Academy of Dermatology, Phi Beta Kappa, and Sigma Xi
Disclosure: Nothing to disclose.

Pharmacy Editor

Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center
Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Jeffrey Meffert, MD, Assistant Clinical Professor of Dermatology, University of Texas Health Science Center-San Antonio
Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, and Texas Dermatological Society
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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