Arms and Legs Papules

Papules on the arms and legs if rough are usually warts and if smoothe consider granuloma annulare.If there is a bit of superficial spreading scale think of tinea corporis.Lichenified eczema on the anterior shins is often papular but other itchy papular disorders such as lichen amyloidosis and hypertrophic lichen planus should also be considered..In white populations sun damage will cause basal and squamous cell skin cancers and rarely colloid milium.

If the papules are tiny think of lichen nitidus.If they are on the wrist or dorsum of the foot and ankle and purplish think of lichen planus.Papules on the palms may be secondary syphilis.Lichen striatus and epidermal nevi commonly involve the arms and legs may do so in a linear fashion.Papular mucinosis is seen more commonly on the extensor forearms and acrokeratosis verruciformis may involve the ankles..Erythema multiforme will give characteristic iris lesions on the lower legs.

Very rare conditions such as multicentric reticulohistiocytosis can present as hand papules.

Management  If you are not sure biopsy it.

SIGN DIP MEN   Overview of Papules

 

This is an extremely difficult area to give an all encompassing nemonic but  SIGN DIP LAPPIS can be used where L=Lichen etc,A=Adnexae,P=Pediculosis,P=Perforating diseases,I=Infiltrates xanthoma etc,and S=Syndromes Grover’s,Darier’s, Albopapuloid EB etc

 

It is probably best to view the differential diagnosis of papules in particular situations

Monomorphic micropapules in a group    Lichen nitidus,keratosis spinulosa,follicular eczema,follicular mucinosis,lichen scrofulosorum,sarcoidosis,lichen planus,keratosis pilaris

 

Polymorphic papules with necrosis     Pityriasis lichenoides ,lymphomatoid papulosis,papulonecrotic tuberculid,Wegener’s granuloma,allergic granulomatosis,leukocytoclastic vasculitis,insect bites,acne necrotica,acnitis.

 

Keratotic papules forming rings or arciform lesions   porokeratoses,perforating collagenoses,Kyrles disease,Elastosis perforans serpiginosa

 

Inflammatory papular dermatitis in children    Gianoti Crosti syndrome,Papular acral located syndrome,papular urticaria,frictional dermatitis,Bindii dermatitis,caterpillar hairs,mite bites,benign cephalic histiocytosis

 

Facial adnexal papules  Syringoma,trichoepithelioma,adenoma sebaceum,benighn cephalic histiocytosis,Cowden’s syndrome

 

Eyelid Papules   Milia,molluscum contagiosum,xanthoma,xanthogranuoma,amyloid,trichoepithelioma,Syringomas,acnitis,Cowden’s,Lipoid proteinosis,papular mucinosis

 

Multiple papules in the mouth    Cowdens,Darier’s,Goltz,florid oral papillomatosis,xanthoma disseminatum,reticulo histiocytosis,lipoid proteinosis,adenoma sebaceum,drugs,pyostomatitis vegetans,verrucous carcinoma

 

Acral papules   warts,Gianotti-Crosti,Cowden’s,Multicentric reticulohistiocytosis,epidermodysplasia verruciformis,viral infection

 

Follicular Papules   Keratosis pilaris,lichen spinulosus,lichen planopilaris,Pityriasis rubra pilaris,lichen sclerosus,follicular mucinosis,discoid lupus erythematosus,vitamin d deficiency,fatty acid deficiency

SIGN DIP NIGL

N Nutritional Vit A,Vit C,essential fatty acid deficiency

I Infiltrates

G Genodermatoses Darier’s,Downs,Kyrles.

L Lichenoid