Dermatofibroma - Western SummaryWestern Medicine Summary

Western Medicine

Western Summary

Dermatofibroma is also known as benign fibrous histiocytoma.

Symptoms

Dermatofibroma is a common benign skin growth that is round, brownish to red-purple growth. It can be raised, flat or sometimes depressed, and may feel like a hard lump under the skin. Dermatofibromas can sometimes form dimpling on the skin when it is pinched. Dermatofibromas vary in size, and can range from the size of a pencil eraser to a nickel. Rarely dermatofibromas can be as wide as a golf ball.[1,2] They can occur in all ages and races, and are more common in women than men. Eighty percent of the dermatofibromas removed by doctors are from people between ages 20 and 49. Dermatofibromas can be found anywhere on the body, but they are most often found on the legs and arms.[3] A person can have a single or multiple dermatofibromas. Very rarely, a cluster of multiple (>15) dermatofibromas can rapidly develop on the legs, and is usually seen in children and young adults.[4] Dermatofibromas usually do not cause symptoms, but can sometimes be traumatized and become painful or itchy.

Causes

The exact cause of dermatofibroma is unknown, but several factors may be linked to its development:

  1. Dermatofibromas may grow as a reaction to infection or trauma. They sometimes develop after a bug bite or small injuries such as a splinter, injection site, or nicks from shaving. In many ways dermatofibroma are like special type of scar: they grow after a skin injury and are made of disorganized collagen fibers.[4,5]
  2. Dermatofibromas may be a benign tumor formed by over dividing fibroblasts, a type of cells in the skin that produces collagen.[5]
  3. Dermatofibromas have been reported to develop after starting several groups medications, such as medications to treat viral infections,[6] anti-tumor necrosis factors,[7] and tyrosine kinase inhibitors such as imatinib.[8]
  4. Altered immune system. Multiple rapidly developing dermatofibromas can rarely grow on people with weakened immune system such as those who have HIV. They can also grow in people with autoimmune disorders such as systemic lupus erythematosus.[9-11]
  5. Several other medical conditions have been linked to the quick occurrence of multiple dermatofibromas:
    • Thyroid disorders: Hashimoto thyroiditis[12] and Grave’s disease[13]
    • Leukemias and lymphomas: cutaneous T-cell lymphoma,[11] multiple myeloma,[11] leukemias,[14,15] and myelodysplastic syndrome.[16]
    • Myasthenia Gravis[13]
    • Dermatomyositis[17]
    • Atopic dermatitis[18]
  6. A family with several members developing multiple dermatofibromas suggest that may be a genetic link to dermatofibromas.[18,19]

Treatments

Dermatofibromas are harmless and do not turn into skin cancers, therefore they are best left alone. Dermatofibromas usually do not go away on their own, but occasionally the center of the growth may become flatter with time.[5] However, when they are itchy or painful, or when cosmetics is a concern, they can be surgically removed. However, the scar from surgical removal can sometimes be worse than the dermatofibroma. There is no topical cream that can treat dermatofibroma. The following medications have been used with dermatofibromas:

  • Topical steroids can be used to when the dermatofibromas are itchy or inflamed, but will not remove the growths.[20,21]
  • Intralesional steroids can be done by injecting cortisone directly into the dermatofibromas. This may flatten the dermatofibromas and help with itching.[21]
  • Shave removal is better used for raised dermatofibromas. It is performed by surgically shaving off the top of the dermatofibroma using a surgical blade. This method is less suitable for flat or depressed dermatofibromas.[4,5,21]
  • Punch removal is can be performed on raised, flat or depressed dermatofibromas. It is performed by removing the dermatofibroma using a punch instrument that look like a small cookie-cutter. Generally, stitches are needed to close the surgical wound.[4,5,21]
  • Excision can be performed by completely removing the entire dermatofibroma and some of its surrounding tissue. Stitches are required to close the surgical wound.[4,5,21]
  • Cryotherapy can flatten or remove dermatofibromas. This is done by freezing them with liquid nitrogen.[22]
  • Various lasers can be used to treat and destroy dermatofibromas.[20,23-25]
  1. Pusztaszeri M, Jaquet PY, Williamson C. Giant hemosiderotic dermatofibroma: a case report and review of the literature. Case Rep Dermatol.2011;3(1):32-36; PMID: 21487458.
  2. Requena L, Farina MC, Fuente C, et al. Giant dermatofibroma. A little-known clinical variant of dermatofibroma. J Am Acad Dermatol.1994;30(5 Pt 1):714-718; PMID: 8176009.
  3. Han TY, Chang HS, Lee JH, et al. A clinical and histopathological study of 122 cases of dermatofibroma (benign fibrous histiocytoma). Ann Dermatol.2011;23(2):185-192; PMID: 21747617.
  4. Goldstein BGaGAO. Overview of benign lesions of the skin. www. uptodate.com. Last accessed March 20, 2016.Last updated November 2015PMID.
  5. Jean Bolognia JJ, Julie Schaffer. Third Edition, Volume 2. Elsevier Publishing. Dermatology. PMID.
  6. Bachmeyer C, Cordier F, Blum L, et al. Multiple eruptive dermatofibromas after highly active antiretroviral therapy. Br J Dermatol.2000;143(6):1336-1337; PMID: 11122056.
  7. Caldarola G, Bisceglia M, Pellicano R. Multiple eruptive plaque-like dermatofibromas during anti-TNFalpha treatment. Int J Dermatol.2013;52(5):638-641; PMID: 22804251.
  8. Llamas-Velasco M, Fraga J, Solano-Lopez GE, et al. Multiple eruptive dermatofibromas related to imatinib treatment. J Eur Acad Dermatol Venereol.2014;28(7):979-981; PMID: 24321053.
  9. Massone C, Parodi A, Virno G, et al. Multiple eruptive dermatofibromas in patients with systemic lupus erythematosus treated with prednisone. Int J Dermatol.2002;41(5):279-281; PMID: 12100703.
  10. Garcia-Millan C, Aldanondo I, Fernandez-Lorente M, et al. [Multiple eruptive dermatofibromas in 2 patients infected with the human immunodeficiency virus]. Actas Dermosifiliogr.2007;98(10):702-706; PMID: 18035028.
  11. Zaccaria E, Rebora A, Rongioletti F. Multiple eruptive dermatofibromas and immunosuppression: report of two cases and review of the literature. Int J Dermatol.2008;47(7):723-727; PMID: 18613883.
  12. Lopez N, Fernandez A, Bosch RJ, et al. Multiple eruptive dermatofibromas in a patient with Graves-Basedow disease. J Eur Acad Dermatol Venereol.2008;22(3):402-403; PMID: 18269629.
  13. Kimura Y, Kaneko T, Akasaka E, et al. Multiple eruptive dermatofibromas associated with Hashimoto's thyroiditis and myasthenia gravis. Eur J Dermatol.2010;20(4):538-539; PMID: 20406729.
  14. Alexandrescu DT, Wiernik PH. Multiple eruptive dermatofibromas occurring in a patient with chronic myelogenous leukemia. Arch Dermatol.2005;141(3):397-398; PMID: 15781688.
  15. Maughan C, Kolker S, Markus B, et al. Leukemia cutis coexisting with dermatofibroma as the initial presentation of B-cell chronic lymphocytic leukemia/small lymphocytic lymphoma. Am J Dermatopathol.2014;36(1):e14-15; PMID: 23974225.
  16. Bhattacharjee P, Umar SA, Fatteh SM. Multiple eruptive dermatofibromas occurring in a patient with myelodysplastic syndrome. Acta Derm Venereol.2005;85(3):270-271; PMID: 16040422.
  17. Huang PY, Chu CY, Hsiao CH. Multiple eruptive dermatofibromas in a patient with dermatomyositis taking prednisolone and methotrexate. J Am Acad Dermatol.2007;57(5 Suppl):S81-84; PMID: 17097372.
  18. Yazici AC, Baz K, Ikizoglu G, et al. Familial eruptive dermatofibromas in atopic dermatitis. J Eur Acad Dermatol Venereol.2006;20(1):90-92; PMID: 16405617.
  19. Samlaska C, Bennion S. Eruptive dermatofibromas in a kindred. Cutis.2002;69(3):187-188, 190; PMID: 11926338.
  20. Wang AS, Larsen L, Chang S, et al. Treatment of a symptomatic dermatofibroma with fractionated carbon dioxide laser and topical corticosteroids. J Drugs Dermatol.2013;12(12):1483-1484; PMID: 24301252.
  21. J.C. P. Dermatofibroma. www.emedicine.com. Last accessed March 20, 2016.PMID.
  22. Wilson EK, Deweber K, Berry JW, et al. Cutaneous infections in wrestlers. Sports Health.2013;5(5):423-437; PMID: 24427413.
  23. Sardana K, Garg VK. Multiple dermatofibromas on face treated with carbon dioxide laser: the importance of laser parameters. Indian J Dermatol Venereol Leprol.2008;74(2):170; author reply 170-171; PMID: 18388391.
  24. Krupa Shankar DS, Kushalappa AA, Suma KS, et al. Multiple dermatofibromas on face treated with carbon dioxide laser. Indian J Dermatol Venereol Leprol.2007;73(3):194-195; PMID: 17558056.
  25. Alonso-Castro L, Boixeda P, Segura-Palacios JM, et al. Dermatofibromas treated with pulsed dye laser: Clinical and dermoscopic outcomes. J Cosmet Laser Ther.2012;14(2):98-101; PMID: 22384809.