What Are Fibrous Papules?

Fibrous papules, or angiofibromas, are small benign bumps on the skin that do not change in appearance throughout a person’s lifetime. These small spots are usually flesh-colored and may resemble a mole. The most common location for a fibrous papule to develop is on the face, especially on and around the nose. Most papules appear late in adolescence or during early adulthood, and bumps that suddenly appear later in life should be promptly evaluated by a medical professional. Treatment is not necessary unless removal is desired for cosmetic reasons.

The majority of fibrous papules develop as a singular lesion. When multiple papules form at the same time, it is often part of systemic condition such as tuberous sclerosis or multiple endocrine neoplasia type 1. Diagnosis usually occurs after a visual inspection and biopsy of the bump. Biopsy results will indicate an increase in blood vessels in the dermis of the skin and underlying fibrous stromal tissue.

Fibrous papules often resemble other, more serious lesions that require medical treatment. Reddish bumps may indicate the spots are caused by adenoma sebaceum, and their presence should lead to a screening test for tuberous sclerosis. Another form of lesions that are similar in appearance are called Koenen tumors, and any bumps of this type require medical treatment. Basal cell carcinomas may look similar as well, but grow much faster than the benign spot. A healthcare professional should assess any quickly growing or changing bump on the skin.

When these bumps are removed, it's usually an outpatient procedure. One hour before the appointment to remove the bump, an analgesic cream will be applied to the skin around the papule to numb it. After injecting a local anesthetic, a medical professional will quickly scrape away the small lesion with short horizontal strokes in a process called shave excision. He will then cauterize the site to prevent infection and promote a faster healing time.

Other methods of fibrous papule removal are curettage, elliptical excision, or laser removal. Laser treatment options include the pulsed dye laser, the CO₂ laser, the KTP laser, or the argon laser. Each laser variation results in different after-care guidelines and healing times.

The fibrous papule will sometimes grow back in the same location after a few months. If the lesion returns, a follow-up appointment to remove the new growth will be scheduled. This procedure may need to be repeated several times if the fibrous papule may come back more than once.

A fibrous papule on the nose is a small spot that people tend to develop in early to mid-adult life. Typically, the papule will measure 1-5 millimeters. It is usually firm and can look like a small dome or like a skin tag or small wart. It may be the same color as your skin but can also have a red appearance. Fibrous papules occur due to aging. They are non-cancerous growths and typically only occur one at a time, although some people do develop more. The papule is made up of blood vessels and collagen. It does not typically carry any symptoms, so you'll only know it is there because you see it.

Before you can consider fibrous papule removal, it must be properly diagnosed. A doctor can do this by performing a skin biopsy. From there, he or she will find the distinctive properties of the papule, such as multinucleated cells, a fibrotic stroma, or dilated blood vessels. Once diagnosed, you will be able to decide whether you want treatment. Treatment is not a requirement because fibrous papules are harmless. However, some people prefer to have them removed for cosmetic reasons. This can be done in a number of ways, including a shave biopsy, laser therapy, cryotherapy, electrosurgery, or excision.

While the specifics of your removal depend on the type you choose, typically, they follow the same basic pattern. First, your doctor will inject you with a local anesthetic that numbs the area and prevents the removal from being painful. Then, he or she will remove the fibrous papule. Afterward, you'll have a superficial wound. The doctor will cover it in a bit of antibiotic ointment to prevent an infection. It will scab over and heal in about a week's time. Your doctor may also perform histological testing on the papule. After healing, a close-up examination may show a small scar, but it is typically not noticeable.

Aftercare and recovery for fibrous removal are quite easy. You'll need to avoid any heavy exercise for the rest of the day so that you don't sweat onto the area. It needs to be kept dry and clean while it heals. Use water and a cotton pad to cleanse the area as needed. You can go back to work the same day. If the wound is in an area that is prone to rubbing, such as where your glasses sit, then your doctor will provide you with a dressing for it.

Once removed, fibrous papules rarely grow back. On the rare occasion that it does return, you can opt to have it removed again if you prefer. Keep in mind that because fibrous papule removal is considered a cosmetic procedure, most insurance companies will not cover it. However, removal is not very expensive. It typically costs between $150 and $500, depending on the size of the fibrous papule. You can talk to your dermatologist to learn about the specific cost for you.