Fibrous Papule: How to Eliminate it?

Treatment #1 for a fibrous papule: the CO2 laser.

Most often, fibrous papules are treated using a CO2 laser. This laser emits high-intensity infrared light that specifically targets the water present in the superficial skin cells. By heating this water, the laser causes a controlled vaporization of the affected tissues, without altering the neighboring cells. The thermal energy not only eliminates the lesion but also stimulates the coagulation of blood vessels, which limits bleeding and promotes healing. The CO2 laser is considered a very precise and minimally invasive technique, interesting for small fibrous papules.

A study conducted on 10 volunteers with fibrous papules demonstrated the effectiveness of this technique. After one to six sessions of CO2 laser treatment, spaced a few weeks apart, 9 out of 10 patients observed a complete disappearance of their fibrous papules. However, it is important to note that half of them saw their fibrous papule replaced by a slight hypertrophic scar, which completely disappeared only in 2 individuals. Despite this, 9 volunteers rated themselves as "satisfied to very satisfied" with the CO2 laser treatment.

Following a CO2 laser session, it is common to observe a slight redness and swelling around the treated area, but these usually disappear within a few days. It is also possible to see thin crusts forming during the healing phase, before falling off after about a week. It should be noted that it is important to use sun protection in the following weeks. The CO2 laser indeed makes the skin more sensitive to UV rays and, without protection, it could develop hyperpigmentation.

Note : CO2 laser sessions are generally not recommended for pregnant or breastfeeding women and individuals undergoing photosensitizing treatment, as a precautionary principle.

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Treatment #2 for a fibrous papule: Cryotherapy.

Fibrous papules can also be removed by cryotherapy, a method that relies on the application of intense cold to destroy unwanted tissues through rapid freezing. The principle of cryotherapy is to create a thermal shock. Indeed, the contact of the cryogen, such as liquid nitrogen, with the skin, freezes the water contained in the cells of the fibrous papule, forming intracellular ice crystals. These crystals cause mechanical damage and disrupt the cellular membrane, leading to the destruction of the cells. The intense cold also causes an initial constriction of the blood vessels, followed by a vasodilation when returning to physiological temperature, contributing to tissue repair.

The freezing of the fibrous papule causes its temporary hardening and the appearance of slight redness and swelling around it. A crust then forms in the days following cryotherapy, before falling off spontaneously. Similarly to the CO2 laser, the use of sunscreen in the following weeks is necessary to protect the skin weakened by cryotherapy. It should be noted that this method is less common in the case of fibrous papules as it carries a greater risk of scarring than the CO2 laser.

Note : Cryotherapy is not recommended for pregnant women and individuals suffering from certain severe cardiovascular or respiratory diseases.

Treatment #3 for a fibrous papule: Electrocoagulation.

Electrocoagulation is also a viable option for treating a fibrous papule. This method relies on the use of high-frequency electric current to heat and destroy the excess tissue of the papule. The goal of electrocoagulation is to induce a localized coagulation of the papule's cells, leading to their necrosis and gradual disappearance. Indeed, the electric current is not limited to the epidermis, but can also penetrate the deeper layers of the skin to reach the entirety of the fibrous papule. Electrocoagulation allows for the removal of the blemish but is precise enough to preserve the surrounding skin structures.

Another advantage of electrocoagulation is its hemostatic effect: the electric current immediately cauterizes small blood vessels, which limits bleeding during and after the procedure. After an electrocoagulation session, the fibrous papule slightly darkens and forms a crust in the following days. Depending on the depth and size of the papule, one or more sessions may be necessary to achieve its complete disappearance. Once again, a strict sun protection is recommended after the procedure.

Note : Electrocoagulation is contraindicated for pregnant women, hemophiliacs, those suffering from certain heart diseases, as well as individuals with a pacemaker.

Treatment #4 for a fibrous papule: surgical excision.

In cases of large fibrous papules, surgical excision is generally preferred. As the name suggests, this technique involves removing the fibrous papule using surgical instruments for a complete and direct elimination of the tissue. Once the area is anesthetized, the surgeon uses a scalpel or a surgical knife to incise the skin around the fibrous papule and remove the excess fibrous tissue. Unlike other less invasive methods, surgical excision ensures that the entire papule, including its dermal base, is removed. If the wound is significant, it can then be sutured.

It is crucial to maintain good hygiene following the procedure, in order to prevent any infection and promote a quick healing. The surgeon typically prescribes antiseptic and healing ointments for the first few days after the excision. To minimize the risk of scarring and hyperpigmentation, it is also recommended not to expose the area to the sun during the healing phase and to diligently use sun protection if it cannot be covered. Lastly, in case of blood discharge, abnormal sensitivity, or persistent redness after the excision, it is important for the patient to get back in touch with their doctor.

Before choosing any of the methods presented above, we recommend you to seek advice from your dermatologist, so they can guide you towards the treatment most suitable for your situation.