Piezogenic Pedal Papules*

Dear Editor, A 24-years-old female sought medical assistance with complaints of a two-year history of bumps on her heels, initially asymptomatic, getting intensely painful over the time. She was generally healthy, and practiced running regularly. Physical examination revealed multiple skin-colored papules on both heels, more evident under pressure (Figure 1). Histopathological exam showed thickening of the stratum corneum (Figure 2). The diagnosis of painful piezogenic pedal papules (PPPP) was made. PPPP were first described by Shelley and Rawnsley (1968).1,2,3 As the name “piezogenic” suggests, lesions are generated caused by pressure (“piesis”), inducing herniation of footpad’s fat through the dermis.1-4 Constitutive fragility of the connective tissue may permit penetration of fat into upper layers of the skin, what would explain its association with congenital defects of the collagen, such as Ehlers-Danlos syndrome (EDS).1-5 Our patient presented with typical lesions: soft skin-colored to yellowish papules, located on the side of the heel, which became more apparent if subjected to pressure.1,3,4 There is description of a higher occurrence of piezogenic papules in runners (as in the current case), triathletes and individuals exposed to long periods of standing due to the greater time that soles are exposed to pressure.1 In a population-based study, DOI: http://dx.doi.org/10.1590/abd1806-4841.20154884