Painful Piezogenic Pedal Papules in a Female Babysitter: A Case-Based Review.
Painful Piezogenic Pedal Papules in a Female Babysitter: A Case-Based Review.
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女保姆的疼痛性足部丘疹：基于病例的回顾。
DOI：
10.1097/dad.0000000000001129
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发表时间：
2019
期刊：
影响因子：
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通讯作者：
王亮春
中科院分区：
文献类型：
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作者：
江泽鑫;谭国珍;李伯有;李希清;王亮春
致编辑：致压性足丘疹（PPPs）的特点是皮肤颜色的隐藏病变，只有在负重或压力应用可见。PPP通常出现在两个脚跟上。在这里，我们报告的情况下，PPP，这只涉及右脚跟。患者女，40岁，右足跟部多发性疼痛性丘疹2年。长时间站立后疼痛更明显。体格检查发现右脚跟内侧有多个0.5-1.0 cm大小的软质、相对界限清楚的皮肤色丘疹（图1A）。按压足跟侧，这些丘疹更加突出（图1B）。她的病史和家族史并不重要。她做了多年的保姆，从来没有超重，并否认任何与病变有关的创伤事件。组织学检查显示表皮正常，真皮深层有数个脂肪小叶，周围有致密的胶原纤维（图1C）。结合临床表现，诊断为PPP，建议使用加压袜，避免长时间站立。文献中足丘疹的患病率差异很大：2.4%、62%和100%。[1]这种差异可能归因于疾病的隐匿性。它出现在儿童和成人身上，没有明显的性别偏见。PPP的发病机制尚不清楚。大多数学者认为这是脂肪穿过真皮层形成的疝。重复性应激、创伤和结缔组织缺损是导致PPP发生的主要因素，因为大多数已发表的病例是运动员、肥胖受试者或Ehlers-Danlos综合征患者。我们的病人是一个保姆，一个需要长时间站立和行走的工作。此外，她可能有一些习惯性的姿势，使她的右脚跟处理更多的压力，她的体重比她的左脚跟，最终导致单侧病变。压力源性丘疹通常表现为足跟部多发性、0.2-1.0 cm大小、皮肤色的软丘疹，
To the Editor: Piezogenic pedal papules (PPPs) are featured by skin-colored hidden lesions and visible only on weight bearing or pressure application. PPP often presents on both heels. Here, we report a case of PPP, which only involved the right heel. A 40-year-old Chinese woman presented multiple painful papules for 2 years on her right heel. The pain was more pronounced after prolonged standing. Physical examination identified multiple, 0.5-1.0-cm sized, soft, relatively well-demarcated, and skincolored papules on the medial aspect of her right heels (Fig. 1A). These papules were more prominent by pressing the heel side (Fig. 1B). Her medical and family history was not significant. She worked as a babysitter for years, was never overweight and denied any traumatic events related to the lesions. Histopathological examination revealed normal epidermis with several fat lobules surrounded by dense collagen fibers in deep dermis (Fig. 1C). Together with the clinical manifestation, she was diagnosed with PPP, and advised to use compression stockings and to avoid longtime standing. The prevalence of pedal papules varied widely in literature: 2.4%, 62%, and 100%. 1 The discrepancy may be attributed to the secretiveness of the disease. It appears in children and adults without apparent sexual bias. The pathogenesis of PPP is unclear. Most scholars believe it is a herniation of fat through the dermis. Repetitive stress, trauma, and connective tissue defect are the major factors contributing to the development of PPP because most of the published cases were athletes, obese subjects, or patients with Ehlers-Danlos syndrome. Our patient was a babysitter, a job requiring longtime standing and walking. In addition, she might have some habitual gesture that makes her right heel handle more stress of her body weight than her left heel, eventually resulting in the unilateral lesions. Piezogenic papules generally present as multiple, 0.2-1.0-cm sized, soft and skin-colored papules on heels,