Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Blatter; Nodules; Papula; papule; sublimity of the skin

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Flat, spherical or pointed conical efflorescence protruding above the skin, up to 1.0 cm in diameter (larger raised efflorescences are called plaque or nodules ) Efflorescence of different colour, consistency and configuration. Their consistency ranges from soft, firm to hard (e.g. calcinosis cutis). Their surface can be smooth, rough or scaly. In a cutting pattern, papules appear as flat, flat-oval, hemispherical or pointed conical prominences.

General information
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In the differential-diagnostic classification of a skin disease a distinction has to be made between a solitary papule or between multiple papules as partial symptom of a localized or generalized disease (e.g. papular exanthema in case of an undesired drug reaction or in case of a classical infectious disease). In most cases, this distinction can be made by ophthalmological diagnosis. It is of decisive importance for the further course of examination (exclusively regional examination or full body examination). Other groundbreaking aspects to be recorded by ophthalmological diagnosis are the distribution pattern of a papular or maculo-papular exanthema, its dynamics and the assessment of the general condition.

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Basically, in the differential diagnostic evaluation of a dermatosis defined by papules, numerous different clinical aspects must be considered and evaluated. These include:
  • Size
  • Number and distribution (solitary, multiple, grouped, disseminated, exanthematic)
  • Arrangement and shape (gyriated, herpetiform, serpiginous, in Blaschko lines, segmental, anular, polygonal, reticular
  • Structural and functional assignment (follicular, sweat glands, sebaceous glands, contact points or defined by exogenous triggers (e.g. contact point, heliotropic, random, textile covered)
  • Topographic classification (different body regions, field skin, groin skin, face, nose, auricle, capillitium, intertriginous)
  • Boundary (sharp-edged, blurred, arched, jagged, random)
  • Colour (dull red, light red, deep red, haemorrhagic, transition to purpura, blue-red)
  • Temperature (hypo-, normo-, hypertherm)
  • consistency (unchanged, slightly to moderately increased [palpable erythema]/ transition to papule)
  • Symptoms (mild itching, severe itching, burning itch, pain)
  • association with fever and/or other general symptoms (arthralgias, intestinal symptoms, fatigue)
  • association with metabolic diseases, pregnancy, malignant tumours, autoimmune diseases
  • dynamics (static, acutely volatile, acutely persistent, chronically persistent, crescendo reaction with increasing dynamics, wave dynamics, with increasing phase-plateau phase and decrescendophase)
  • Triggering: Exogenous Triggering: Physical: cold, heat, pressure, UV, light), biochemical (exertion; water; irritants), allergic (contact allergens)
  • Triggering: Endogenous triggering: bacterial, viral, fungal infections, ADRs (drug reactions), food allergies.

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  1. Altmeyer P (2007) Dermatological differential diagnosis. The way to clinical diagnosis. Springer Medicine Publishing House, Heidelberg
  2. Nast A, Griffiths CE, Hay R, Sterry W, Bolognia JL. The 2016 International League of Dermatological Societies' revised glossary for the description of cutaneous lesions. Br J Dermatol. 174:1351-1358.
  3. Ochsendorf F et al (2017) Examination procedure and theory of efflorescence. Dermatologist 68: 229-242


Last updated on: 29.10.2020