How to treat piezogenic papules?

In cases of persistent or bothersome piezogenic papules, several therapeutic options are available.

• Corticosteroid injections.

  Sometimes combined with anesthetics, corticosteroid injections can reduce discomfort associated with piezogenic papules by decreasing the levels of pro-inflammatory cytokines. They are particularly beneficial for individuals whose papules cause chronic pain. However, it's important to note that corticosteroid injections are contraindicated for patients suffering from diabetes, bone disorders such as osteoporosis, or healing problems, as corticosteroids can disrupt tissue regeneration.

• Electro-acupuncture.

  Less invasive, electro-acupuncture is a technique that involves applying thin needles and sending low-intensity electrical impulses to stimulate local circulation. The goal is to reduce tissue congestion and thus alleviate pain and piezogenic papules. Although electro-acupuncture is generally well tolerated, it is not recommended for patients with heart conditions, particularly those with pacemakers, or coagulation disorders, as it can cause hematomas at the needle insertion sites.

• The wearing of compression stockings.

  When piezogenic papules are associated with venous insufficiency, doctors may prescribe compression stockings. These stockings exert a decreasing pressure, stronger at the ankle and decreasing towards the top of the leg, which promotes venous return by facilitating blood flow from the feet towards the heart. Moreover, by limiting venous stasis, compression stockings reduce the pressure in the veins of the feet and ankles, which decreases the risk of worsening piezogenic papules. However, caution is needed regarding compression stockings: it is important that they are individually adjusted as inappropriate pressure can cause discomfort and exacerbate circulation problems.

• Surgical excision.

  If piezogenic papules are symptomatic, surgical excision may be considered. This procedure involves surgically removing the overgrowth of adipose tissue by excising the affected area. The operation requires local anesthesia and, although it is relatively minimally invasive, it can result in scarring, hyperpigmentation, or post-operative local sensitivity. Its success largely depends on the location of the piezogenic papules and the patient's healing capacity, which can be more delicate in the heel region.

• The low-intensity laser.

  Finally, low-intensity laser therapy could be a solution for piezogenic papules. This is suggested by a study conducted with two volunteers suffering from painful piezogenic papules. After ten sessions of low-intensity laser therapy spread over fifteen days, the scientists observed a disappearance of the patients' papules. Although the small number of participants calls for caution, these results are nonetheless encouraging. If we look at how it works, the low-intensity laser acts by increasing local blood circulation, which reduces edema. It also stimulates the tissue repair process in cells and decreases pain.