Flexures Papules

Papules in the flexures

 

Flexural warts

Papules in the flexures are usually simple things such as skin tags and seborrhoeic keratoses particularly in the axillae and under the breasts in women and warts which like moist occluded surfaces.However rarer conditions such as the itchy papules of Fox Fordyce disease or the dark papules of acanthosis nigricans and the similar condition confluent and reticulated papillomatosis will involve the axillae.Itchy inflammatory papules in the groin may be secondary to Pubic lice and their egg casings should be sought for on the hair shafts.Molluscum contagiosum particularly likes the pubic skin area and the groin as it may be spread sexually in adults.Ulcerating flexural papules in a neonate should make you think of Langerhans cell histiocytosis In children you can also see the unilateral laterothoracic exanthem giving a linear red scaly rash in one axilla or flexure..

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