Fibrous Papule on Nose | Causes, Diagnosis, and Treatments

Have you ever had a small bump on the outside of your nose and wondered what it is, what caused it, and how you can get rid of it?

That small bump might be a fibrous papule. Yeah, most of the bumps that appear on people's noses are fibrous papules. They are pretty common.

Today’s article aims to explain all there is about fibrous papule on nose. What causes it? Its diagnosis and treatments. So, keep reading to find out what you need to know about fibrous papules.

First of all, what is a Papule?

Papule is an elevated, solid, palpable lesion that is ≤ 1 cm in diameter. Papule may be solitary or multiple.

Papules may be:

• Acuminate (pointed)
• Dome-shaped (rounded)
• Filiform (thread-like)
• Flat-topped
• Oval or round
• Pedunculated (with a stalk)
• Sessile (without a stalk)
• Umbilicated (with a central depression)
• Verrucous (warty)

So, what is a Fibrous Papule?

A fibrous papule, also known as adenoma sebaceum, fibrous papule of the face ¹https://emedicine.medscape.com/article/1057309-overview, or fibrous papule on nose, is a firm benign (harmless) bump that most often occurs on the nose and less commonly, on the cheeks, chin, neck, and, rarely, on the lip or forehead.

Fibrous papules are benign small skin-colored lesions (usually less than 5mm in size). Fibrous papules are very common in people in their third to the fifth decade of life.

A fibrous papule is a nasal patch or spot on the nose that appears in early to mid-adulthood. A fibrous papule may range in size from 1mm to 5mm.

A fibrous papule is normally hard and shaped like a little dome, although it may sometimes protrude beyond, similar to a small wart or skin tag. A fibrous papule may be either skin-colored or red.

Fibrous papules of the nose are seen in equal numbers of middle-aged men and women, regardless of race or ethnicity. Fibrous papules on the face usually arise as single lesions; however, occasionally multiple (i.e., normally less than 10) lesions may be present.

However, patients with multiple fibrous papules should be examined for other signs of systemic diseases including tuberous sclerosis ²https://en.wikipedia.org/wiki/Tuberous_sclerosis, neurofibromatosis type 2 ³https://en.wikipedia.org/wiki/Neurofibromatosis_type_II, multiple endocrine neoplasia type 1 ⁴https://en.wikipedia.org/wiki/Multiple_endocrine_neoplasia_type_1, and Hornstein-Knickenberg syndrome ⁵https://en.wikipedia.org/wiki/Birt%E2%80%93Hogg%E2%80%93Dub%C3%A9_syndrome.

Tuberous sclerosis should be considered in children with multiple fibrous papules. Inquire about medical and family history including seizures, mental impairment or developmental delay, behavioral disorders, visual problems, and tumors of the brain, heart, kidneys, lungs, and skin.

Occurring predominantly on the nose, fibrous papules are generally 1-5 mm, shiny, skin-colored, firm, dome-shaped papules. The fibrous papule has a characteristic appearance under the microscope. A fibrous papule is considered a nevus (a birthmark), and develops spontaneously as part of human development.

The precise reason for fibrous papule form is unknown. Fibrous papule is best considered a variant of angiofibroma. A study from 2014 showed the expression of antibodies against p-mTOR in dermal stromal cells and epidermal keratinocytes in fibrous papules, similar to tuberous-sclerosis complex–associated facial angiofibromas, suggesting topical rapamycin may be a treatment option.

Why do fibrous papules occur? – Causes of Fibrous Papule on Nose

Fibrous papules are believed to be caused by an overgrowth of collagen in the skin. Collagen is a tough, fibrous protein that gives structure to the skin. The overgrowth of collagen may be due to the following:

• Genetics
• Sun Exposure
• Family History
• Immunosuppression
• Viral Infections
• Trauma

Fibrous papules are benign (non-cancerous) growths of the skin that occur with aging. An individual usually only has one lesion, or sometimes two. When examined under the microscope, fibrous papules contain collagen and blood vessels. Their medical name is angiofibroma.

Fibrous papules are a result of an overgrowth of dilated blood vessels, fibroblasts, and collagen in a localized area. What triggers this is not well understood. In fact, it’s okay to say that the cause of fibrous papules is not known.

However, patients with multiple fibrous papules should be examined for other signs of systemic diseases including tuberous sclerosis, neurofibromatosis type 2, multiple endocrine neoplasia type 1, and Hornstein-Knickenberg syndrome.

Tuberous sclerosis should be considered in children with multiple fibrous papules. Inquire about medical and family history including seizures, mental impairment or developmental delay, behavioral disorders, visual problems, and tumors of the brain, heart, kidneys, lungs, and skin.

Does Fibrous Papule on Nose Have Any Side Effects? – Symptoms of Fibrous Papules

Some of the fibrous papule symptoms include the following:

• Small, benign growths commonly appear on the nose.
• They are usually round or oval-shaped and range in color from skin-toned to reddish-brown.
• Fibrous papules typically measure 1-5 millimeters in diameter.

While fibrous papules are generally harmless, they can sometimes be a source of cosmetic concern. If a fibrous papule is large or appears on a visible area of the face, it may be removed for aesthetic reasons.

The fibrous papule will not cause any symptoms like pain or itching. However, papules may become inflamed or bleed when irritated or scratched.

If you’re wondering how to cure papules, note that they are not actually cancerous and do not require treatment unless they are causing discomfort or affecting appearance. In some cases, topical medications may be used to shrink the size of the growth. More aggressive treatments, such as laser therapy or surgery, are generally not necessary.

Fibrous papules are frequently asymptomatic. They are removed for aesthetic purposes or because a histological test is necessary. Fibrous papules are small, benign growths that commonly occur on the nose.

Though they are harmless, fibrous papules can be unsightly and cause cosmetic concerns. Fibrous papules can become irritated or inflamed, causing discomfort.

In rare cases, it may indicate the presence of a more serious condition, such as skin cancer. Therefore, it is important to see a doctor if you notice any unusual growths on your skin.

Who Mostly Gets Fibrous Papules?

Fibrous papules are common and may affect anyone. They usually appear during late adolescence and early adulthood. Multiple fibrous papules can be present without any underlying disorder.

The presence of multiple fibrous papules may be associated with genetic conditions including tuberous sclerosis, Birt-Hogg-Dubé syndrome, and multiple neuroendocrine neoplasia type 1 (MEN1).

In these conditions, the papules are numerous and widespread, often beyond the nasal area. They are harmless apart from the psychological problems they may cause due to their visible appearance.

Fibrous Papule Diagnosis

Fibrous papules may be similar in appearance to other skin lesions. They can be differentiated via biopsy and other clinical features:

• Basal cell carcinoma
• Melanocytic naevus
• Dermatofibroma
• Adnexal neoplasms including trichoepithelioma, trichofolliculoma, trichodiscoma, and perifollicular fibroma.

Fibrous papules are diagnosed by skin biopsy. There are distinctive features of histopathology (proliferation of fibroblasts, fibrotic stroma, and dilated blood vessels).

An expert may sometimes detect fibrous papules through a clinical examination. However, distinguishing a fibrous papule from other skin growths such as a mole, hair follicle tumor, or skin malignancies such as basal cell carcinoma may be challenging. There is more information about different growths that may mimic fibrous papules here.

Fibrous papules are most often seen on the nose, although they may appear elsewhere on the face, including on the cheeks, chin, and around lips.

What other problems can occur with fibrous papules?

There are no other problems associated with fibrous papules. Multiple fibrous papules may sometimes be associated with rare genetic conditions including tuberous sclerosis complex, multiple endocrine neoplasia syndrome type 1 (MEN-1) and Birt-Hogg-Dube syndrome.

Tuberous sclerosis is caused by mutations in the genes tuberous sclerosis complex (TSC 1) that encodes the protein hamartin and tuberous sclerosis complex 2 (TSC 2) that encodes the protein tuberin. Multiple endocrine neoplasia type 1 (MEN-1) is due to a mutation in the MEN1 gene which encodes Menin.

Birt-Hogg-Dube syndrome is caused by a mutation in the FLCN gene which encodes folliculin. Clinical findings in Birt-Hogg-Dube include fibrofolliculomas, perifollicular fibromas (some authorities consider perifollicular fibroma to be related to angiofibroma), and trichodiscomas.

These are all present as skin-colored to hypopigmented papules on the head and neck or upper trunk.

How is Fibrous Papule on Nose Treated?

The fibrous papules may be scraped out or cauterized. If it cannot be distinguished from a skin tumor, it is always submitted for histological investigation.

Fibrous papules do not require any treatment. Several options are available for the removal of fibrous papules. Some dermatologists routinely employ surgical procedures such as curettage, shave excision, or elliptical excision with excellent cosmetic results.

Successful treatment with various lasers, including the pulsed dye laser, carbon dioxide (CO2) laser, potassium titanyl phosphate (KTP) laser, and argon laser.

Fibrous papules do not require any treatment but if their appearance is of concern, several options can be considered on an individual basis. These include:

• Cosmetic camouflage
• Excision (the fibrous papule is completely removed surgically): A fibrous papule is a small, benign growth that commonly appears on the nose and cheeks of adults. While they are not harmful, many people choose to have them removed for cosmetic reasons. Excision is a common treatment option for fibrous papules.

During the procedure, the growth is carefully cut out with a scalpel. The surrounding tissue is also removed to ensure that all of the papules are gone. This can be done under local anesthesia, meaning that you will not be put to sleep for the procedure.

Recovery from excision is typically quick and easy. You may have some swelling and bruising around the site of the incision, but this should go away within a week or two. Once healed, the area will be permanently free of the fibrous papule.

• Shave or punch biopsy (removing part of the fibrous papule): A shave biopsy is a type of minor surgery that is used to remove skin lesions. It is a common treatment for fibrous papules, which are small, benign growths that commonly occur on the nose and cheeks.

The procedure is typically performed in a doctor’s office or outpatient clinic. During the procedure, the lesion is numbed with local anesthesia. A small razor is then used to shave off the top layer of skin. The area is then covered with a bandage.

Shave biopsies are generally safe and have a low risk of complications. The main risks are bleeding and infection. Recovery from a shave biopsy usually takes about one week. During this time, it is important to keep the area clean and dry to prevent infection.

• Electrosurgery (using an electrical device to destroy the fibrous papule): Electrosurgery is a treatment for fibrous papules that uses high-frequency electrical energy to destroy the lesion. The procedure is usually performed by a dermatologist or plastic surgeon.

Electrosurgery can be used to treat many different skin conditions, including warts, moles, and skin tags. It is a relatively safe and effective procedure with minimal side effects. The most common side effect is temporary swelling and redness at the treatment site.

Electrosurgery is generally considered a safe and effective treatment option for fibrous papules. However, as with any medical procedure, there are risks and potential complications that should be discussed with your doctor prior to treatment.

• Cryotherapy: Cryotherapy treatment is a type of medical procedure that uses freezing temperatures to destroy abnormal tissue. It can be used to treat a variety of skin conditions, including fibrous papules.

Cryotherapy treatment can be used to remove fibrous papules by freezing them with liquid nitrogen. The procedure is quick and relatively painless and does not usually require downtime.

Cryotherapy treatment can be an effective way to remove fibrous papules. However, it is important to note that this treatment may not be suitable for everyone. If you have any questions or concerns about cryotherapy, be sure to speak with your doctor or dermatologist.

• Laser therapy: Laser therapy treatment is a popular and effective treatment option for fibrous papules. This minimally invasive procedure uses concentrated beams of light to target and destroy the excess tissue that makes up the papule.

Laser therapy treatment is usually performed on an outpatient basis, with minimal downtime or side effects. In most cases, multiple treatments are necessary to achieve desired results.

However, patients can expect to see a significant improvement in the appearance of their skin after just one session.

If you are considering laser therapy treatment for fibrous papules, be sure to consult with a board-certified dermatologist or plastic surgeon who has experience with this procedure. They will be able to determine if you are a good candidate and develop a treatment plan that is right for you.

• Topical application of sirolimus (also called rapamycin which is an mTOR inhibitor) for multiple fibrous papules associated with tuberous sclerosis complex.
• Rapamycin (mTOR inhibitor) has recently gained popularity in the treatment of angiofibromas. After binding to mTOR, rapamycin inhibits its activity which downregulates cell proliferation. Rapamycin also decreases vascular endothelial growth factor (VEGF) production by downregulating VEGF- stimulated endothelial cell proliferation.

Several case series, case reports, and one randomized controlled trial have been published verifying the effectiveness of topical rapamycin used as 0.1% once or twice daily, as well as 0.2%, used 5 times a week and 0.4% used 3 times a week. The angiofibromas cleared as long as the medication was being used.

The longest reported follow-up has been 3 years. Many have used crushed rapamycin tablets and mixed them in Vaseline to obtain the desired concentration which was not a standardized dose.

DeKlotz et al. proposed a standardized formulation on how to make .1% topical rapamycin in 2011. Few if any side effects occur from the topical medication including mild irritation and erythema.

Park et al. showed that topical rapamycin was enough to treat the lesions when they were small in size, that is less than 4 mm. However, if they were larger than 4 mm, ablative resurfacing was needed in conjunction with rapamycin.

It can also be costly to use topical rapamycin in the treatment of angiofibromas due to the length of treatment that is necessary to obtain sufficient results costing several hundred to several thousand dollars out of pocket.

Successful treatment with various lasers, including the pulsed dye laser 10, carbon dioxide (CO2) laser, potassium titanyl phosphate (KTP) laser, and argon laser.

What Occurs During the Removal of Fibrous Papules?

Fibrous papules are removed using two procedures:

• Scrape excision:  The fibrous papule is scraped or shaved. After that, the wound is cauterized.
• Cautery: The skin tag is removed using electrosurgery with a very thin tip.

An injection of local anesthesia is given. As a consequence, a relatively superficial wound develops. This is coated with Vaseline and will scab over and recover in a few days, generally 5 to 7 days.

A dressing is not necessary unless the wound is in a region prone to rubbing or chaffing, in which case it is used to protect the skin until it heals. Histological examinations may be necessary.

Fibrous papules may sometimes return after treatment. Close inspection may reveal a little scar with a change in texture and skin color at the site of the fibrous papule removal.

How does the Skin Recover When a Fibrous Papule Is Removed?

A little scab will form in the treated region and will go off within 5 days. You must use Vaseline four times every day. Small lesions normally heal quickly.

What Happens After a Fibrous Papule Excision in Terms of Aftercare and Recovery?

We urge that you refrain from engaging in any vigorous activity for the remainder of the day. Clean and dry surfaces that have been treated must be maintained. You may clean them with water and a cotton pad once or twice a day.

People may frequently return to their office jobs immediately. A splash-proof dressing is applied to wounds that are prone to rubbing or chaffing.

What are the Dangers of a Fibrous Papule Removal Procedure?

This is a highly safe technique with a high degree of satisfaction in general. Larger lesions may leave a minor scar or mark.

How can I Schedule a Fibrous Papule Removal?

Midland Skin can provide a fibrous papule removal consultation and treatment on the same day. All you have to do is send a photo for evaluation, and they will provide you with a price. When you arrive, the fibrous papule will be checked to determine that it is acceptable for removal, and you will be informed if histology is necessary.

If histological testing is necessary, there is an extra fee. Same-day procedures are only performed when they are judged safe and suitable. A consultation charge applies if treatment is not suited for you or if you decide not to continue with a same-day procedure.

Final Words

A fibrous papule develops during late adolescence or early adult life on the nose, or less often, elsewhere on the face. It is a dome-shaped shiny lesion 2-6 mm in diameter, sometimes bearing a central hair. Although it looks similar to a skin-colored mole (dermal naevus), it is firmer in texture. It is harmless but persists unchanged lifelong.

It is important to distinguish fibrous papule from the common skin cancer, basal cell carcinoma, which may also present as a firm shiny bump. Basal cell carcinoma most often arises later in life. It slowly grows, and tends to bleed and ulcerate.

A fibrous papule on nose is a harmless growth that typically occurs on the nose. While it is not cancerous, it can become irritated and cause discomfort. If this occurs, treatment options are available to reduce symptoms.

With proper care, the fibrous papule on nose is not a cause for concern. If you are in Houston, Texas, and looking for a board-certified plastic surgeon to discuss surgical treatment options, contact Skin Cancer Specialist.

They can determine if fibrous papule removal through surgery is the best option for you and help you decide on the most appropriate procedure. They have locations in Sugarland, Katy, and Conroe, TX.

All right, guys, that is it for now for the fibrous papule on nose. I hope Healthsoothe answered any questions you had concerning the fibrous papule on nose. 

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Additional resources and citations

• 1
  https://emedicine.medscape.com/article/1057309-overview
• 2
  https://en.wikipedia.org/wiki/Tuberous_sclerosis
• 3
  https://en.wikipedia.org/wiki/Neurofibromatosis_type_II
• 4
  https://en.wikipedia.org/wiki/Multiple_endocrine_neoplasia_type_1
• 5
  https://en.wikipedia.org/wiki/Birt%E2%80%93Hogg%E2%80%93Dub%C3%A9_syndrome