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Papules and nodules
Papules or nodules refer to a rash in which the skins or mucous membranes thicken up like nodules. Papules are small, each one measures less than 5 mm. It is not an independent disease, but a symptom of various diseases.
Papules: definition and appearance
Depending on where the papules appear, doctors distinguish between three types of nodules:
Epidermal papules appear in the horny cell layer, the spiked cell layer or the epidermis. Typical nodules of this type are warts, for example.
Cutaneous papules form in the dermis, they are a classic symptom of syphilis. Epidermo-cutaneous papules appear in the dermis and epidermis.
Many papules are just a nuisance. They look ugly, but arise spontaneously and regress just as quickly without scarring. Papules are flat-oval, hemispherical or tapered. They can be soft or firm.
Individually or in groups
There are both single papules and multiple nodules. The doctor can make this initial diagnosis for papules on the epidermis at a glance - the situation is different for thickening in the deeper skin layers.
Multiple papules appear primarily as a partial symptom of a disease, for example in the case of infections, but also as a reaction to medication.
Diagnosis of papules
To make an accurate diagnosis, the doctor examines the size, number and distribution of the nodules: do they occur individually or are there many? Do they concentrate at a certain point, do they form networks?
Then follows the assignment to the functions that the papules could trigger: Are the papules located on sweat and sebum glands? Do they form in places covered by clothing?
The spatial assignment is also important: is the groin skin affected? Or the face, the ear, the nose?
The shape of the individual nodules also provides information about the basic disease: is it variable? With a sharp edge? Blurred? Jagged?
What color are the papules? Skin colors, matt red, light red, blood red? Purple or bluish? What is the temperature of the nodules: normal body temperature, over or under temperature? What is their consistency?
What are the symptoms of the papules? Are they painless, is it an itchy rash or are the nodules itchy? Are they burning? Do they hurt otherwise? Are there any other symptoms, such as fever, nausea, fatigue?
Does the patient suffer from underlying diseases such as a metabolic disorder, weakness of the immune system or malignant tumors?
Are the papules static, do they go away on their own or do they come up again and again? Are there external triggers such as heat, cold, pressure or UV light? Are there internal triggers like bacteria, fungi, viruses or allergies?
Causes of skin nodules
In general, papules can form in the most diverse areas of the body, namely when cells in the skin multiply uncontrollably and the corresponding skin tissue enlarges.
This is because the cells of the cornea also multiply, and we see them on the surface of the skin. One cause of these cell formations are skin diseases that form eczema. A rare disease called "lichen planus" is particularly characterized by papules, as is the so-called nevus cell nevus, a skin change in infants.
Basic diseases with papule formation
Papules usually arise from skin inflammation, which in turn usually forms in response to external substances.
Common triggers are rubber and latex, make-up, soaps, shampoos and gels, chemicals in clothing, toxins in plants, metals in body jewelry such as silver or nickel.
Chickenpox is caused by the varicella zoster virus, is highly contagious and is manifested by a very itchy rash on the whole body. They are easily transmitted through physical contact and saliva, including coughing or sneezing.
Pregnant women are particularly at risk because the mother's chickenpox can harm the fetus, for example by making the child deaf and dumb.
Candidiasis (also candidosis or candidiasis) is not a viral but a fungal disease. Such a fungal infection in humans is most often triggered by the fungus Candida albicans.
4.) Psoriasis denotes a skin disease in which the skin turns red, flakes and also forms papules.
5.) Shingles is an infection with the herpes zoster virus that shows up as a rash with papule formation. The painful area of the skin develops papules, which, however, turn into blisters that are filled with liquid and stand together in small groups. The trunk, arms, legs or neck are usually affected, and the rash can also occur on the face.
6.) Insect bites are not a disease, but also lead to papules. Normal body reactions also show up as itching, pain and burning. Wheals form and the nodules are the size of a pinhead to a lens.
If there is a basic disease, the doctor primarily fights it. The dermatologist is responsible. In addition to medication, surgical intervention is often necessary, on the one hand for aesthetic reasons and on the other hand to clarify whether the papules indicate a tumor.
If it is small papules on invisible parts of the body, waiting is the best motto. They often disappear on their own.
However, if they multiply and cover ever larger areas of the body, those affected should consider surgery, as well as if individual papules enlarge and ignite.
Everyone has papules somewhere on their bodies at some point in their lives. This cannot really be prevented. If nodules have already formed, those affected can at least check them.
You should avoid pressure on the papules as well as rubbing or intense sunlight.
However, if the skin changes indicate a basic disease, the patient should address it.
If allergies are the trigger for skin problems, it is advisable to avoid the substances that trigger the allergy.
You should clean the skin surface on and around the papules regularly. The papule then often dissolves, but sometimes it develops into eczema or catches fire.
Under no circumstances should you try to express the nodules. It is not a pimple or pustule with pus formation. Do not rub the skin while washing.
If you do not know the cause of the papules, avoid body sprays, shampoos etc. where you are not sure whether your skin can tolerate them.
Expose the affected areas to fresh air as often as possible.
Are papules dangerous?
The cause of the papules can be dangerous: if cancer develops or they suffer from syphilis, they are serious and life-threatening changes. However, the skin changes themselves are almost always harmless. (Dr. Utz Anhalt)
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Dr. phil. Utz Anhalt, Barbara Schindewolf-Lensch
- P. Altmeyer: Dermatogische Differentialdiagnose, Springer Verlag, 2007
- Elizabeth H. Page: Description of Skin Lesions, MSD Manual, (accessed September 9, 2019), MSD
- Shinjita Das: Psoriasis, MSD Manual, (accessed 09.09.2019), MSD
- Mercedes E. Gonzalez: Dermatitis - an overview, MSD Manual, (accessed 09.09.2019), MSD
- Dorothea Terhorst-Molawi: Dermatologie Basics, Elsevier / Urban Fischer Verlag, 4th edition, 2015