Trunk Papules

Papules on the trunk include those on the chest,back and abdomen.

Grover's disease

Guttate psoriasis

Multiple papules on the trunk are most likely to be a seborrhoeic keratoses if brown and scaly,Grover's disease if red,itchy and rough,guttate psoriasis if red and scaly,drug reaction if red and itchy, disseminated granuloma annulare or sarcoidosis if purplish and asymptomatic and due to secondary syphilis if they are also present on the palms of the hands.Take a biopsy if you are not sure because the pathologist can certainly separate out a lot of these disorders very easily under the microscope.

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,disseminate and recurrent infundibulofolliculitis,follicular eczema,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,Confluent and Reticulate papillomatosis,

 

Inflammatory papular dermatitis in children    Gianotti-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 Lichen planus

Solitary Papule   Adnexal tumour,Cutaneous focal mucinosis,Neurofibroma,Pilomatricoma,Desmoplastic trichoepithelioma,Leiomyoma

Grouped Papules   Agminate Spitz nevi,Epidermal nevus,Leiomyoma,Molluscum contagiosum,Papular urticaria,Segmental neurofibromatosis

Pruritic papules   Grover's disease,Papular urticaria,Scabies,Atopic eczema,Itchy red bump disease,Drug rash,Dermatitis herpetiformis,Pruritic urticarial papules and plaques of pregnancy