Painless piezogenic pedal papules in a patient with rheumatic heart disease

SK Singh, M Tehseen, A Kalam

 Department of Dermatology, J.N. Medical College, A.M.U., Aligarh, India

Correspondence Address:
S K Singh
Department of Dermatology, J.N. Medical College, A.M.U., Aligarh
India

Introduction

Piezogenic pedal papules are soft, skin coloured papules and nodules, which appear on the side of the heel, usually the medial aspect, when the subject is standing and disappear when weight is taken off the foot.[1] Similar papules have also been noticed on the lateral edge of the hand and wrist.[2]

Case Report

A 14 - year -old girl came with multiple painless, soft, skin-coloured papules on both heels when standing, for 2 months duration. There was no change in size and number of papules within two months. Papules disappeared when weight was taken off. Papules were on medial, posterior and lateral aspect of both heels. There was no pain on standing. There was no history of such type of lesions in family members or relatives. Systemic examination showed features of rheumatic heart disease with mitral regurgitation and pulmonary hypertension. Routine investigations of blood and urine did not reveal any abnormality except mild anemia. Histopathological examination of papules showed normal fat tissue. [Figure - 1]

Discussion

Piezogenic papules are a form of reaction to internal mechanical stress. They are mainly found on feet but can be found on hand and wrist. Papules appear when weight is put on that particular area. Papules may be painful when there is herniation of fat in to the dermis with a resultant reduction in dermal thickness.[3] Postulated reasons for this pain include a defect in septation of the adipose tissue and ischaemia due to extrusion of fat within its vascular supply and associated nerves.

The frequency of the condition makes it difficult to assess the assertion that piezogenic pedal papules can be familial[4] and also that there is an increased frequency in Ehlers - Da nlos syndrome.[5] Since piezogenic pedal papule has not been reported in association with rheumatic heart disease, we report this case.

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