Papules

Introduction The papules are localized protrusions that are higher than the skin, as small as needles, as large as soybeans, may be tall or flat, smooth or scorpion-like structures, or have pigments that are the same color as the surrounding skin (ones larger than 1 cm in diameter, called plaques), many The lesions that begin with skin diseases arise from pimples and should be closely observed and diagnosed. A variety of skin diseases can manifest as papules. Some only show pimples alone, and some are accompanied by other skin lesions. The pathogenesis of papules is located in the epidermis or the upper part of the dermis. Therefore, from the pathological point of view, the mechanism of causing papules is the accumulation of certain metabolites in this part; or the localized hyperplasia of epidermal or dermal cells; or inflammatory edema and various parts of the site. Infiltration of cells can manifest as papules. Deposition of metabolites: The papules such as amyloidosis of the skin are caused by dermal papillary amyloid deposition. The new type of edema of the edema of the moss is a large amount of protein deposition from the upper part of the dermis. The papules of the gelatinous measles are caused by the infiltration of homogeneous gel-like masses in the dermal papilla. The papules caused by the localized hyperplasia of epidermal or dermal cells, such as common warts, flat warts, and psoriasis, are hyperproliferative epidermal cells that cause epidermal bulging. German and cutaneous fibroids also form papules for proliferating cells.

Cause

The papules caused by the limited edema of the epidermis are found in eczema and contact dermatitis. Clinically, it is characteristic because various cells infiltrate the papules caused by the epidermis or dermis. Suppurative inflammatory papules are mainly neutrophil infiltration; chronic inflammatory papules are mainly lymphocyte infiltration; allergic factors cause papules to be eosinophil infiltration; tuberculous papules are epidermoid cell lymphocytes Cell infiltration; syphilitic papules infiltrated by plasma cells; xanthomatosis is characterized by foam cell infiltration. The pathogenesis of papules is related to its pathogenesis.

First, inflammatory papules

(1) Infectious inflammatory papules

1. Virus-infected papules: measles, rubella, infantile acute rash, echovirus rash, infantile papular dermatitis, common warts. Flat warts, condyloma acuminata, verrucous epidermal dysplasia, varicella, herpes zoster, Bowenoid papulosis.

2. Bacterial infection of papules: folliculitis, sores, sputum, verrucous skin tuberculosis, papular necrotic tuberculosis, inguinal granulation month, soft under cancer.

3. Spirochetic infection of papules: hard sores, l-phase measles, yaw.

4. Mycotic infection of papules: handcuffs, athlete's foot, femoral hernia, body lice, sputum rash, coloring fungal disease.

5. Parasitic insects infected with papular hookworm dermatitis, hair follicle dermatitis, pruritus, acne, rickets, bed bugs, bites, and mosquito bites.

(2) Non-infectious inflammatory papules

1. Pain in allergic skin diseases: contact dermatitis, eczema, atopic dermatitis, drug eruption, papular and other measles.

2. Pimples of papular scaly skin disease: psoriasis. Parapsoriasis, flat moss dance, sclerosing atrophic premolar, red pityriasis, gestational papular dermatitis, golden yellow moss, lustrous moss, small spine moss.

3. Pimples of neurological dysfunction: neurodermatitis, pruritus, nodular pruritus, pregnancy pruritus.

4. Vasculitic papules: allergic purple epileptic allergic skin vasculitis, persistent erythema, and malignant atrophic papulosis.

5. Physical factors of papules: red miliary rash, keratotic hemangioma, pleomorphic sun rash, photolinear reticulosis, corns, frictional moss-like rash.

6. Papular sebaceous gland secretion factors: seborrheic dermatitis, acne vulgaris, neonatal acne, rosacea, perioral dermatitis.

Third, non-inflammatory papules

1. Metabolic factors of papules: skin amyloidosis, edema edema, gradual necrosis of lipidoids, xanthomatosis, vitamin A deficiency.

2. Genetic keratotic papules: follicular keratosis, keratosis of the hair, keratosis of the bronchial tube, keratoderma of the palm of the palm, sacral keratosis, nodular sclerosis.

3. Papular manifestations of skin tumors: pigmented disease, hemangioma, syringoma, periplasmic keratosis, fur epithelial tumor, lymphoid reticuloma, municipal granuloma, lymphomatoid papulosis.

an examination

Related inspection

Sputum test sexually transmitted disease research laboratory test cryptococcal disease complement binding test typhus sinus serological test serum immunoglobulin (Ig)

Many skin diseases can manifest as papules during the pathogenesis, but their papules have certain characteristics. Some pimples are the main symptoms of the disease; some pimples evolve into watery pus. Nodules or plaques; some papules may exist alone; some papules may be associated with other skin lesions; some papules are not difficult to diagnose according to their characteristics; others rely on medical history, physical examination, laboratory tests, histopathology A comprehensive analysis can make a correct diagnosis.

Physical examination

Papria can be a major symptom of a skin condition, or it can be a reflection of a systemic disease, and a full physical examination should be done if necessary.

The distribution of papules is localized or systemic, is symmetric or unilateral, is distributed along the nerve or is distributed in the vascular lymphatic vessels. Such as systemic papules are seen in systemic factors such as measles-like drug eruptions, localized papules are seen in local factors such as folliculitis, handcuffs; symmetrical papules are found in eczema, isolated pimples such as common warts, clustered papules such as sweat ducts, along the nerves The distribution is seen in the early papules of the banded cancer.

The size, number, color and shape of the papules are related to the diagnosis. For example, the tip of the needle is found in rubella, the emergency of the child, the needle is seen in the scorpion, the sweat herpes, the miliary is seen in the flat wart, the folliculitis, the bean is found in the common warts, and the psoriasis. The number of pimples is only one or a few pimples, and the measles-like drug eruption is widespread. The roads vary in color, such as red for psoriasis and yellow for yellow tumors. The shape is conical in folliculitis, hemorrhoids, flat in flat warts, flat moss dance, central depression is contagious soft palate, central necrosis is seen in papular necrotizing tuberculosis, mound rubella is seen in banded pityriasis, surface papillary is seen in common Hey, silvery white scales on the surface are seen in psoriasis.

The arrangement of papules is linear in the arrangement of lines. The papules produced by the homomorphic reaction are found in the flat moss, the flat sputum, and the papules distributed along the lymphatic vessels. The nodules are found in the arrangement of the sclerotium. The shape or rainbow shape is characteristic of pleomorphic erythema.

The area of the pimples, such as hemorrhoids, occurs on the face and chest and back, and the lichen is on the cheeks and back of the hands. Papules can also occur in many parts, and a certain part can be a good site for a variety of skin diseases. According to the occurrence of papules, it is often a good site for some skin diseases. The diagnosis is summarized as follows:

(1) Head papules are found in: seborrheic dermatitis, psoriasis, head lice, folliculitis, sputum, sputum, etc.

(2) facial pimples are found in: hemorrhoids, flat vermiculite dermatitis, eczema, pigmented detox rash, erythema multiforme, tuberous sclerosis, cutaneous epithelioma, facial miliary lupus, syringoma, jaundice, Colloidal mump rash, basal cell epithelial tumor effusion keratinization.

(3) cervical papules are found in: neurodermatitis, folliculitis, sputum, contact dermatitis, solar moss, skin tuberculosis, etc.

(4) Torso pimples are found in: psoriasis, pityriasis rosea, drug eruption, viral rash, disease, acne, contagious soft palate, sputum sputum folliculitis, eczema, herpes-like dermatitis, herpes zoster, etc.

(5) Peripheral papules are found in: pruritus, skin amyloidosis, meridian dermatitis, eczema, papular necrotic tuberculosis, flat moss, allergic purple epilepsy, psoriatic, psoriasis, red pity.

(6) Hand and foot papules are found in: eczema, dermatitis, hand, foot and sputum, sputum rash, acne, erythema multiforme, flat wart, common wart, flat moss, hair red pityriasis, roller.

(7) genital perianal papules are found in: psoriasis, lichen planus, genital warts, syphilis, hemorrhoids, pubic sputum, candida infection, Bowenoid papulosis, eczema, dermatitis, atrophic and sclerosing.

Laboratory inspection

Virus-infected papules, the total number of white blood cells is low or normal. Can detect the DNA gene detection of pathogenic microorganisms. Bacterial infection with papules associated with fever blood neutrophils can be elevated. The pus culture is bacteriologically positive. Fungal papules are directly mirrored, positive for fungal culture or culture. The syphilitic papules can be tested positive for the syphilis test. Tuberculous papules can be tested or cultured for tuberculin. Various papules can be taken for pathological examination of living tissue when necessary to aid diagnosis.

Differential diagnosis

First, infectious inflammatory papules

(a) virus infected pimples

1. Measles: Measles virus infection, more common in children under 5 years old, rash on the 4th day after fever. The lesion is characterized by a rose rash.

2. Rubella: For rubella virus infection, more common in young children, 1-2 days before rash, mild fever with enlarged lymph nodes in the neck. It is a reddish rash or pimples.

3. Children's acute rash: For Coxsackie BO virus infection, infants and young children aged 6 months and 2 years old are more common. The damage is rose rash.

4. Echo virus rash: It is infected with Echo virus and is more common in children. Often 2-5 rashes after fever, the lesions are purple-red maculopapular rash. There are red and yellow papules in the phlegm and throat.

5. Infant papules: Sexual acral dermatitis is generally considered to be a primary infection of the hepatitis B virus through the skin ring membrane through the skin mucositis. More often in young children. There was no obvious anterior area symptoms and a sudden rash. No needle to mung bean large flat fully papules, dark red, first in the back of the hand and foot 3 to 4d in turn extended to the thigh, buttocks, limbs and face, the trunk is less rash. May be associated with systemic lymphadenopathy and acute recurrent hepatitis, with a course of 2-8 weeks.

6. Common sputum: is a human papillomavirus (HPV) type 1, 2, 4 infection. From the beginning, it is a large papule of the needle, gradually increasing to the bean grain or larger, round or irregular shape, the surface is rough and keratinized obviously papillary-like hyperplasia, hard to touch, 1 to dozens, well in the hand Or the foot. The skin lesions of the ankle and foot are called road rollers.

7. Flat : For HPVI, 3, 5, 8, 9 type bow. Skin lesions to large flat papules; light red, light brown or normal skin tone. Occasionally on the face, back of the hand or forearm. Itchy or not itchy, chronic course or sudden loss of skin lesions.

8. Condyloma acuminata: HPVJ1 type infection. From the beginning, it is a small red papule, which gradually increases, and the surface is moist and soft, and the unevenness is papillary, chapter-like or cauliflower-like. Occurs in the external genitalia and perineum, perianal, can also occur in the urethra, cervix, umbilical fossa or lip. Often caused by sexual contact or indirect infection.

9. Verrucous epidermal dysplasia: caused by HPV types 3, 58, 9, 10, and 12. Many years of childhood illness or any age. It is a large flat papule of miliary to soy, round or polymorphous, dark purple or light brown. The papules are densely distributed symmetrically, which occur in the face, neck, trunk and limbs, and the course of the disease is chronic.

10. Infectious soft palate: caused by soft prions, more common in children and young people. From the beginning, it is a large hemispherical papule of rice grains, and gradually becomes a waxy luster on the large surface of the bean. The central depression is like a umbilical fossa. The top is broken and the white cheese-like material forest can be squeezed out to soften the small body, and the damage varies. Occurs in the trunk, limbs, and can be contacted.

11. Chickenpox, banded pityriasis: caused by chickenpox-striped rash virus. It started as a macule, quickly turned into a papule, and eventually developed into a water sore.

12. Bowen-like papulosis: may be HPV1, 16 type infection. Occurs in the skin and mucous membranes of the genital and perianal genitalia. Lesions are reddish brown single or multiple papules, round or irregular. #2-10 mm, the surface is bright or slightly keratinized in a braided shape, arranged in a line or cluster, slightly itchy or wide-angled.

(b) bacterial infection of pimples

1. Folliculitis

Mostly red inflammatory papules caused by Staphylococcus aureus infection. It is characterized by a large needle or miliary, a small yellow pus on the top, and conscious pain. Occasionally on the face, neck, chest and back.

2. Sore

A folliculitis that occurs in the beard. Occurs between the upper lip and the nose and the forehead. For the follic inflammatory papules, there is a hairy perforation in the center, which has a slight itching or burning pain. Can develop into small follicular pustules.

3.

It is a deep folliculitis caused by staphylococcal infection and inflammation around the hair follicle. Occurs in the face and neck, tube. Initially a follicular red inflammatory papule, which in turn increases to small or larger inflammatory nodules. Local redness and heat pain, the top suppuration is yellow.

4. Sickle skin tuberculosis

Infected skin for Mycobacterium tuberculosis At the beginning, the bean has a large dark red papule, which later grows into a nodule, which is hard and continues to expand to form a keratinized plaque.

5. Pimple necrotizing tuberculosis

The skin lesions caused by Mycobacterium tuberculosis are spread to the skin. The multi-distribution limbs are large hard papules from mung bean to soybean, dark red or purple-red, with necrosis in the center, and atrophic epilepsy remains after the formation of small ulcers.

6. Inguinal granuloma

It is a granulomatous Klebsiella infection that is often transmitted through sexual contact. Damage often occurs in the external genitalia, perineum, perianal and groin. From the beginning, it is a hard nucleus or nodule. The ulceration forms a pink ulcer, and the septic pus has a foul smell. There are papillary-like hyperplasia at the margin, no symptoms, no lymph nodes, long-term formation of thin tubes, hypertrophic epilepsy and pigmentation.

7. Soft squat

Infected with Haemophilus Duke, transmitted through sexual intercourse. The incubation period is 2-5 days, and a red papule appears in the external genital area, which in turn becomes an abscess forming ulcer, and the edge is not consciously painful. Small satellite-like ulcers can occur around it.

(c) spirochetes infected with spirochetes

1. Hard squat

The first rash after infection with the skin of Treponema pallidum, the skin lesions from the soybeans to 1cm large copper solid asymptomatic papules or induration, mostly in the external genitalia, can be cured after about 4 weeks.

2. Mei rash

Skin lesions are diverse, such as psoriasis-like papules, mossy papules, corneal papules, and rose-like papules. It is characterized by symmetrical asymptomatic skin lesions with palm and two skin lesions, and the syphilis serum test is positive.

3. Yas

A pimples infected with yaws. Flat or hemispherical papules occur at the site of primary infection, and purulent secretions are present on the enlarged surface. The second phase of yaw rash can show the scattered symmetrical distribution of soybean or broad bean large flat papules. After the surface is smooth, there is a secretion to form a yellow idiot.

(four) fungal infection of pimples

1. Hand, foot and ankle

Caused by Epidermidis, can also be caused by Candida and yeast-like bacteria. Occasionally between the fingers (toes) and fingers (toes) or palms and feet. In particular, the hand rubs are mostly unilateral, and the lesions are needles to miliary papules and mounds. There are also keratinized desquamation, erosion and impregnation, clinically can be divided into water sore type, rubbing type and scaly keratosis type. Self-conscious itching, positive for fungal examination.

2. Body, share

It is mainly caused by Epidermidis such as Trichophyton rubrum, which is caused by Trichophyton rubrum, Trichophyton rubrum and Flocculigo. The primary skin lesions are papules or herpes, which gradually expand and fuse to form a ring, which reduces central inflammation, clear peripheral margins, and positive fungal tests.

3. Sputum rash

The antigen released by the primary fungal infection (foot) causes antigen-antibody reactive lesions in the distant site. A papule or small otter appears on the side of the palm or finger. The skin lesions of the moss-like papules showed a large papule of the needle, a maculopapular rash or a follicular papule, which appeared in a group of moss-like drugs. Occasionally on the shoulders and back can also be seen in the limbs or the whole body.

4. Coloring fungal disease

It is caused by a deep fungal disease, a coloring fungus, a densely colored fungus, a dermatitis coloring fungus or a sclerotium. It is characterized by local erythematous papules from the primary infection site, gradually increasing to nodules, and fused into plaque or sickle or parenchymal lesions. Fungal examination and histopathology can aid diagnosis.

(5) Parasites and insect infected pimples

1. Hookworm dermatitis

The hookworm larva invades the skin for about a few minutes, and it has a tingling and burning sensation. It has a maculopapular rash, papules, a herpes, or a wheal of it. The secondary infection can resolve in about 1 week. 2. Hair follicle dermatitis is a chronic inflammation caused by Demodex in the hair follicles or sebaceous glands. The rash is mostly on the face of young people. From the beginning, the erythema is gradually becoming a follicular red papule. Like wine slag-like or acne-like skin lesions but no blackheads, purulent papules can also occur. 3. Itchy itch is also known as "barley itch" and "straw itch". It is caused by contact with mites and is more common in people who come into contact with cereals. The skin is bitten by a tapeworm and itchy papules can also occur.

4. Scabies

Caused by . Clinically, needle-to-miliary red papules and herpes can form tunnel-like lesions. More often in the finger joints, forearm flexion, lower abdomen and inner thigh. The lesion that occurs in the scrotum of the penis is a red nodule. Itching is heavy at night and there is a history of infection.

5. Rickets

It is caused by the parasitic human body, and the bite sucks blood to cause pimples. Consciously itchy, often found in the gaps in the clothes.

6. Bed bugs, running cockroaches, mosquito bites, erythematous papules or mump cancer rashes in the bitten area.

Second, non-infectious inflammatory papules

(a) allergic papules

1. Contact dermatitis

It is the skin or the membrane that comes into contact with a certain substance and the skin lesion occurs at the contact area. Can be expressed as erythema. Pimples, water sores or big cockroaches. Clinically divided into primary irritant and allergic. The former is a strong irritant to the skin, and can occur after contact. The latter is basically non-irritating to the contact, and only a few people are exposed to the substance after sensitization and then contact with the skin lesions. This allergy phenomenon is type IV delayed allergic reaction.

2. eczema

It is a delayed type of allergic reaction caused by complex internal and external stimulating factors. It is characterized by morphological changes in skin lesions, symmetry of distribution, recurrence, and severe itching. Papular and herpes are the main manifestations of acute eczema.

3. Atopic dermatitis

The cause is more complicated and is generally considered to be related to multiple factors. Genetic factors are the main factors in this disease. Patients often have congenital allergies, and the incidence of infants and young children is more, mainly manifested as erythematous papules. The disease is divided into three stages at different ages. Infancy occurs on the head and face, and can also develop into the trunk and limbs, showing dense needles and large papules on the erythema. Herpes, water cancer and exudate. The dry type of rash is a dense small papule with a dry surface and scales. About 80% of children are diagnosed before the age of 5, and are classified into eczema and pruritus according to the form of rash. The former is a large needle of acupuncture, a herpes or a small leeches, which can be fused into a piece, which occurs in the elbow fossa in the womb; the latter is a whole test of miliary to mung bean big pimples, skin color or brown, and the dry surface of the papule is rough and thin. Idiot, scratches or bloody idiots, itchy and intense. The adult rash is erythematous papules. After fusion, it is flaky and infiltrated with hypertrophy.

4. Drug eruption

It is a rash that occurs when the drug enters the human body through various routes and causes skin and new membrane reaction. The skin lesions of drug eruptions are diverse and have many clinical manifestations. Measles-like drug eruption is a broadly symmetric distribution of rice grains with large red papules, which can be fused together. The papules are sparsely scattered and densely confluent, and the disease is itchy. It is the most common type of drug eruption. In recent years, more is caused by ampicillin. Polymorphous erythema type drug eruption, characterized by mung bean to broad bean large round edematous erythematous papules, central water cancer or purple-red, more symmetry occurs in the limbs. Acne-like drug eruption, manifested as follicular papules similar to acne, often caused by iodine, fillings, corticosteroids. A purple epilepsy or vasculitis-type drug eruption, which is characterized by needles, beans or larger purple epilepsy, with raised skin and necrosis at the center.

5. Measles and other measles

It is generally believed that delayed allergic reactions caused by mosquito bites, or allergic reactions caused by food, drugs, etc. Found in infants and children with more incidence. The rash is a red wheal-like rash that is scattered or clustered in the limbs or trunk. Mung bean to peanuts are large, slightly spindle-shaped, and some can have small water cancer in the center. New and old rash often exist at the same time. Self-conscious itching, rash repeated.

(b) papule scale attribute skin disease pimples

1. The cause of psoriasis is unknown. At the beginning of the skin lesions, it is an inflammatory red papule. The miliary to large granules are gradually enlarged and merged into plaques. The surface is covered with silvery white scales. The scaly is scraped off and a shiny film is called film phenomenon. The occurrence of punctiform bleeding is a feature of this disease.

2. Parapsoriasis drip-type parapsoriasis is more common, and the lesions are distributed on the trunk and limbs, but not on the head. The lesion is a red spotted papule of the size of the bean, which has a slow course and no punctiform bleeding. The acne-like parapsoriasis is rare, and it is a large round papule from the needle to the bean, and the herpes is easy to be necrotic.

3. The flat moss has a flat papule, purple-red, miliary to large, polygonal, and clear boundaries. Itching is obvious, and the skin lesions can also be fused into small patches.

4. The sclerosing atrophic moss skin lesion is a porcelain white flat papule with a small blackhead acne-like hair follicle horny plug on the surface, surrounded by a flush. The papules begin to be large, round or irregular, with some central depressions and hard palpation.

5. Hair red pityriasis can be divided into congenital or acquired, the former is often the child and the latter is seen in adults. Occasionally on the back of the finger l-2 knuckles is characterized by it. Extending the limbs and the trunk. The face can also be involved. Lesions are follicular keratotic papules and scaly reddish plaques.

6. The cause of golden yellow moss is rare in clinical practice, and can occur in both adults and children. The skin lesion is a large flat hill of rust-colored miliary. The rash, the cluster is mossy. The pathological change has a broad normal connective tissue area in the upper part of the dermis, with a banded infiltration under it, mainly lymphocytes and a small number of tissue cells.

7. The cause of lustrous bitter is unclear, and children can be diagnosed by the elderly. The lesions are needles to miliary papules, round or polygonal, with hemispherical bulges or cones or flat. It can be normal skin tone, light e color or light red. The solid surface is bright and does not fuse. It occurs in the penis, glans, abdomen and forearm. Pathological changes, local spheroidal mononuclear cells infiltrated in the dermal papilla at each papule lesion, and the epidermal processes on both sides were extended.

(c) pimples caused by neurological factors

1. Neurodermatitis begins to itch in the skin of the affected part. After the scratching, there is a large papule of miliary to bean, round or polygonal, and then gradually merged and become mossy, which occurs in the neck, elbow, energy and other parts.

2. Itching is a group of acute or chronic inflammatory papular skin diseases. Acute simple pruritus, a common middle-aged woman, is a sudden flat papule of mung bean to soybean, which is initially pale red and then becomes dark red and scattered. Itchy pruritus, small papules, more often accompanied by wind corps disappeared quickly, and later a solid papule. Occurs in the limbs or torso.

3. Nodular pruritus is generally associated with mosquito bites. From the beginning, it is a red pimples, and then becomes a hemispherical nodule. The beans are hard to touch, the surface is rough, reddish brown, itchy, scratching and scratching. Occurs in the extremities of the extremities, especially in the calf extension side. 4. Pregnancy pruritus is found in pregnant women, especially pregnant women with more than two times of pregnancy. It is a reddish or normal skin pimples. Mung beans are large and scattered in symmetry. They occur in the trunk, upper arm and thigh. The cancer is severe and it is very night.

(four) porcine inflammatory skin disease pimples

1. Allergic purple plague is a superficial small vasculitis with small and scattered skin lesions. The stagnation point is slightly higher than the leather surface, and the rash is a symmetry of the extremities. Especially the bipedal and lower legs are good sites.

2. Allergic skin vasculitis lesions are pleomorphic, which may be erythema, papules, wheal and purple epilepsy, but the characteristic lesions are purple epilepsy rash, which may cause blood cancer or necrosis. Occurs in the lower limbs and ankles. The pathological changes were swelling and occlusion of dermal capillaries and small vascular endothelial cells, and fibrin degeneration and necrosis in the wall. There are neutrophil infiltration and nuclear fragmentation around the vessel wall.

3. Peripheral ridges with erythema lesions are clusters of small papules and small nodules, which are later expanded into characteristic plaques, initially bright red, followed by purple-yellow, which occurs in the extremities and hands and feet.

(5) pimples caused by physical factors

1. Red miliary rash, also known as Jizi, is a high temperature and humidity, and the micrococcus on the skin is multiplied and blocked by the sweat gland duct sweat. It is characterized by a large, dense papule or mump cancer rash.

2. Keratotic hemangioma is associated with cold freezing injury and is a purple-red vascular papule, often found in the back of the hands and feet.

3. Polymorphic sun rash is associated with daylight exposure. Occurs in the exposed area. Skin lesions are red maculopapular rashes, and water sores or nodules can also occur.

4. Photolinear reticulosis is associated with daylight sensitivity. The skin lesions are miliary or mung bean. The bright red papules gradually merge into plaques, which occur in the exposed parts of the skin.

(6) Pimples caused by sebaceous gland secretion factors

1. Seborrheic dermatitis

It is thought to be related to the infection of the oval-shaped sputum. The skin lesions are red papules around the hair follicles, and the papules gradually merge into red and yellow patches of varying sizes, which are covered with greasy scales. Occurs in the head, forehead, eyebrows, nasolabial folds and nose, but also in the armpits, pubic bones and groin.

2. Hemorrhoids

Endocrine factors, sebum action and microbes in the hair follicles. Most occur in adolescent men and women. Occurs in the face such as the forehead, cheeks and forehead, can also occur in the upper chest and back, the skin lesions are follicular red papules, accompanied by whiteheads or blackheads, can also be expressed as abscesses, nodules or cysts.

3. Neonatal acne

Blackheads appear on the face of children after birth or within 2 years of age. Initially for follicular papules, abscesses can also occur. There is often a clear family history.

4. Rosacea

The cause is not very clear, and can be related to vasomotor dysfunction, overeating, mental stress and so on. There are also concerns about hair follicles with Demodex infection. More common in middle-aged people aged 30-50. Skin lesions occur in the center of the face, such as the nose and nose, and can also occur in the cheeks, forehead, and forehead. Skin lesions are erythema, papules, and sepsis and nodules can also occur.

5. Perioral dermatitis

More common in young women, skin lesions occur around the mouth, but there is a narrow "no skin loss circle" around the red edge of the lips. The skin lesions were red papules, maculopapular rash or acupuncture rash, clustered, with a little abscess between them, and the course was chronic.

Third, inflammatory papules

(a) papules of metabolic skin diseases

1. Amyloidosis of the skin: It is deposited on the skin by amyloid material, which is a large keratinized hemispherical papule of miliary, which is hard to be combined with each other. The densely integrated sheets or arrays are beaded, and the itch is obvious. It is often caused by scratching and scratching.

2. Ya fluid edema moss: also known as edema on protein disease. It is a skin disease caused by the proliferation of skin fibroblasts, the deposition of acidic new polysaccharides, and the clinical classification is limited or systemic, which is characterized by mossy-like papules.

3. Progressive necrosis of lipidoids: About two-thirds of patients have diabetes, and skin lesions occur on the calf extension. Initially dark red hard papules, after expansion and fusion into plaque, flaky limp lesions.

4. Xanthomatosis: related to lipid metabolism. Often accompanied by increased blood lipids. The skin lesions are yellow papules or small nodules. Hemispherical or flat, characterized by agglomerated lipid foam cell infiltration in the dermis.

5. Vitamin A deficiency: also known as ecdysis. The lesions are miliary large conical follicle keratotic papules with sharp horny thorns in the center and dense papules.

(two) pimples caused by genetic keratogenic factors

1. Follicular keratosis

It is caused by poor keratinization of epidermal cells, and the skin lesions are small and full of follicular papules, which gradually become orange-like or stained gray, and the surface is covered with greasy adhesive scales or idiots, which can be densely fused into plaques.

2. Keratosis

Also known as keratosis around the hair. For needles with large skin color or reddish hair follicle papules, the top has a conical angle plug, the hair is pierced or twisted from the center. The papules are densely distributed on the outside of the upper arm or on the side of the thigh.

3. Swollen keratosis

For the crater-shaped keratotic papules, the ring shape can be enlarged, the central micro-atrophy shrinks, the moldworm disappears, and the edge is levee-like bulge.

(3) Papular manifestations of skin tumors

1. Pigment

Also known as cancer cell disease. The skin lesions are maculopapular rashes, papules are nipples, strong, nodules, etc., which occur in the face, neck and trunk. Light brown or dark brown.

2. Hemangioma

For needles, miliaries, large or larger pebbles-like lesions, red or purplish red.

3. Sweat tube tumor

Fortunately at the moment, the forehead is a pale yellow surface with a waxy luster, and the needle is slightly flattened to the miliary.

4. Mildew

For the white needle of the face to the miliary papules, it occurs in the skin around the eyes, the surface is smooth, and the white matter can be picked up with the tip of the needle.

5. Seborrheic keratosis

Also known as the old age. Occasionally on the face, back of the hand, forearm, etc., brown flat papules or patches.

6. Hair epithelioma

Also known as cystoid adenoid epithelioma, which occurs on the face, is a hard pimples complexion, and has a sense of transparency.

7. Nodular sclerosis

Also known as sebaceous adenoma. For dominant inheritance, it occurs in the lower part, which is a tough, yellow capillary dilatation papule with mental retardation and epilepsy.

8. Lymphoid reticular tumor

Its skin lesions can also manifest as papules. For example, in the early stage of mycosis fungoides, the lesions are pleomorphic, which may be erythema, papules, wheal, etc., lymphoma-like papules, or may be reddish-brown papules.

Many skin diseases can manifest as papules during the pathogenesis, but their papules have certain characteristics. Some pimples are the main symptoms of the disease; some pimples evolve into watery pus. Nodules or plaques; some papules may exist alone; some papules may be associated with other skin lesions; some papules are not difficult to diagnose according to their characteristics; others rely on medical history, physical examination, laboratory tests, histopathology A comprehensive analysis can make a correct diagnosis.

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