Papules

CLINICAL DIAGNOSTIC MANUAL

Papules are small, solid, elevated skin lesions typically measuring less than 1 cm in diameter. These lesions can appear individually or in clusters and may be of various colours, including red, pink, brown, or skin-coloured. Papules can indicate a range of dermatological conditions, both benign and malignant.

Pathology	Symptoms and Clinical Signs	Suspected Diagnosis	Confirmatory Diagnosis
Acne	Inflammatory and non-inflammatory papules, comedones. Common on face, chest, and back.	Medical history and physical examination. Dermatoscopy.	Confirmation with physical examination and dermatoscopy.
Scabies	Itchy papules, scratch lines. Localised in intertriginous areas.	Medical history and physical examination. Dermatoscopy, skin scraping microscopy.	Confirmation with dermatoscopy and positive skin scraping for mites.
Viral wart	Hyperkeratotic papules, commonly on hands and feet. Asymptomatic or painful.	Medical history and physical examination. Dermatoscopy.	Confirmation with physical examination and dermatoscopy.
Molluscum contagiosum	Umbilicated papules with a central waxy core. Common in children and immunocompromised adults.	Medical history and physical examination. Dermatoscopy.	Confirmation with physical examination and dermatoscopy.
Contagious ecthyma	Pustular papules evolving into ulcers. Painful and exudative.	Medical history and physical examination. Bacterial culture.	Confirmation with positive bacterial culture.
Campbell de Morgan spots	Red angiomatous papules. Common on trunk and upper limbs.	Medical history and physical examination. Dermatoscopy.	Confirmation with physical examination and dermatoscopy.
Cutaneous papillomas	Pedunculated or sessile papules. Localised in friction areas.	Medical history and physical examination. Dermatoscopy.	Confirmation with physical examination and dermatoscopy.
Milia	Pearly white papules. Common on the face, especially eyelids and cheeks.	Medical history and physical examination. Dermatoscopy.	Confirmation with physical examination and dermatoscopy.
Insect bites	Itchy papules with erythematous halo. History of insect exposure.	Medical history and physical examination.	Confirmation with physical examination and observation of resolution.
Early seborrheic keratosis	Hyperpigmented, warty papules. Common in sun-exposed areas.	Medical history and physical examination. Dermatoscopy.	Confirmation with physical examination and dermatoscopy.
Xanthomas	Yellowish papules. Associated with dyslipidaemias.	Medical history and physical examination. Lipid profile.	Confirmation with lipid analysis and physical examination.
Guttate psoriasis	Erythematous papules covered with silvery scales. Common on trunk and limbs.	Medical history and physical examination. Skin biopsy.	Confirmation with skin biopsy and histopathological analysis.
Lichen planus	Purplish, polygonal, itchy papules. Localised on wrists, ankles, and lower back.	Medical history and physical examination. Skin biopsy.	Confirmation with skin biopsy and histopathological analysis.
Chronic lichenoid pityriasis	Erythematous papules evolving into hyperpigmented lesions. Common on trunk and limbs.	Medical history and physical examination. Skin biopsy.	Confirmation with skin biopsy and histopathological analysis.
Heat rash (miliaria)	Itchy papules in areas of excessive sweating. Common in axillae, neck, and trunk.	Medical history and physical examination.	Confirmation with physical examination and environmental control.
Keratosis pilaris	Keratotic papules on the upper arms and thighs. Asymptomatic or itchy.	Medical history and physical examination. Dermatoscopy.	Confirmation with physical examination and dermatoscopy.
Blue nevus	Blue or greyish papules. Common on extremities.	Medical history and physical examination. Dermatoscopy.	Confirmation with physical examination and dermatoscopy.
Basal cell carcinoma	Pearly papules with superficial telangiectasias. Common in sun-exposed areas.	Medical history and physical examination. Skin biopsy.	Confirmation with skin biopsy and histopathological analysis.
Malignant melanoma	Pigmented, asymmetric papules with irregular borders. History of lesion changes.	Medical history and physical examination. Skin biopsy.	Confirmation with skin biopsy and histopathological analysis.
Darier’s disease	Erythematous, warty papules. Mainly in sebaceous areas (face, chest, back).	Medical history and physical examination. Skin biopsy.	Confirmation with skin biopsy and histopathological analysis.
Acanthosis nigricans	Hyperpigmented, warty papules. Localised in skin folds (neck, axillae).	Medical history and physical examination. Glucose and insulin tests.	Confirmation with physical examination and laboratory tests (glucose, insulin).
Pseudoxanthoma elasticum	Yellowish papules in flexural areas. History of progressive skin changes.	Medical history and physical examination. Skin biopsy.	Confirmation with skin biopsy and histopathological analysis.
Tuberous sclerosis	Angiofibromatous papules on face and body. Associated with epilepsy and mental retardation.	Medical history and physical examination. Genetic evaluation.	Confirmation with genetic evaluation and physical examination.