A dermatofibroma, also known as a benign fibrous histiocytoma, is a common, benign (non-cancerous) skin growth that is usually found on the lower legs. It is typically about 1-2 centimeters in diameter and is firm to the touch. Dermatofibromas are usually flesh-colored or brown, and they may be slightly raised above the skin surface. They are not usually painful, but they may be itchy or tender.
The exact cause of dermatofibromas is unknown, but they are thought to be caused by a reaction to trauma to the skin, such as an insect bite or a scratch. Dermatofibromas are more common in women than men, and they are most common in people between the ages of 20 and 50.
In most cases, dermatofibromas do not require treatment. They will usually go away on their own within a few months to a year. However, if a dermatofibroma is large or unsightly, it can be removed surgically. Dermatofibromas can also be treated with laser therapy or cryotherapy.
There are several different types of dermatofibromas, including:
- Superficial dermatofibromas are the most common type of dermatofibroma. They are usually small and flesh-colored.
- Deep dermatofibromas are larger and more deeply embedded in the skin. They may be brown or black.
- Atypical dermatofibromas are dermatofibromas that do not look like typical dermatofibromas. They may be larger, more raised, or have a different color.
- Angiofibromas are dermatofibromas that are associated with blood vessels. They may be red or purple.
- Periungual dermatofibromas are dermatofibromas that occur around the nails. They may be painful.
Dermatofibromas are usually harmless, but they can sometimes be mistaken for other types of skin growths, such as skin cancer. If you have a dermatofibroma, it is important to see a doctor to get a diagnosis and to rule out any other possible causes of your skin growth.
Causes
The exact cause of dermatofibromas is unknown, but they are thought to be caused by an injury to the skin, such as a bug bite, insect bite, or scratch. They may also be caused by an allergic reaction to something in the environment.
Most dermatofibromas do not require treatment. They will usually go away on their own within a few months to a year. However, if a dermatofibroma is large or unsightly, it may be removed surgically.
Here are 20 possible causes of fibrous dermatofibroma:
- Injury to the skin. Dermatofibromas are thought to be caused by an injury to the skin, such as a bug bite, insect bite, or scratch. The injury can cause the body to produce more collagen, which is a protein that helps to heal wounds. The excess collagen can form a tumor, which is a mass of tissue that grows abnormally.
- Allergic reaction. Dermatofibromas may also be caused by an allergic reaction to something in the environment, such as a metal, chemical, or medication. The allergic reaction can cause the body to produce more histamine, which is a chemical that causes inflammation. The inflammation can lead to the formation of a dermatofibroma.
- Genetics. Dermatofibromas may run in families, which suggests that there may be a genetic component to their development.
- Hormones. Dermatofibromas are more common in women than in men. This may be due to the effects of hormones, such as estrogen and progesterone.
- Age. Dermatofibromas are more common in adults than in children. This may be because the skin becomes more fragile with age and is more likely to be injured.
- Race. Dermatofibromas are more common in people of African descent than in people of other races. This may be due to genetic differences.
- Immune system. People with weakened immune systems, such as people with HIV/AIDS, are more likely to develop dermatofibromas. This is because their immune systems are not able to fight off infections as effectively, which can lead to the formation of tumors.
- Certain medications. Some medications, such as corticosteroids, can increase the risk of developing dermatofibromas.
- Certain medical conditions. People with certain medical conditions, such as diabetes and rheumatoid arthritis, are more likely to develop dermatofibromas. This may be due to changes in the body’s immune system or hormones.
If you have a dermatofibroma, it is important to see a doctor to rule out any other possible causes of the lump. The doctor will likely ask you about your medical history and examine the lump. They may also order a biopsy, which is a procedure to remove a small piece of tissue for testing. A biopsy can help the doctor to determine if the lump is cancerous.
Symptoms
The most common symptom of a fibrous dermatofibroma is a small, firm, painless lump on the skin. The lump may be skin-colored, pink, red, brown, or black. Fibrous dermatofibromas are usually found on the legs, but they can also occur on the arms, trunk, or face.
Other symptoms of a fibrous dermatofibroma may include:
- Itching
- Tenderness
- Bleeding
- Ulceration
- Swelling
- Pain
If you have any of these symptoms, see your doctor to get a diagnosis.
Diagnosis
Essential diagnosis and tests used to identify fibrous dermatofibroma.
- Physical Examination: A dermatologist will visually inspect the skin lesion to assess its size, color, texture, and location. They will note any additional symptoms or associated skin changes, such as tenderness or discoloration. Physical examination provides crucial initial insights into the presence of fibrous dermatofibroma.
- Dermoscopy: Dermoscopy involves the use of a handheld device called a dermatoscope to examine the skin lesion in detail. This non-invasive technique allows dermatologists to observe the structure and patterns within the lesion, such as the presence of pigmented dots or a central white scar. Dermoscopy aids in distinguishing fibrous dermatofibroma from other skin conditions.
- Biopsy: A biopsy involves the removal of a small tissue sample from the lesion for laboratory analysis. It is the most definitive diagnostic test for fibrous dermatofibroma. The excised tissue is examined under a microscope to confirm the presence of fibrous tissue and ruling out other potential conditions.
- Histopathology: Histopathology involves the microscopic examination of the biopsy sample. A pathologist analyzes the tissue structure, cellular composition, and presence of fibrous tissue. This examination confirms the diagnosis of fibrous dermatofibroma and differentiates it from other similar lesions.
- Immunohistochemistry: Immunohistochemistry utilizes specific antibodies to detect and identify cellular markers present in the tissue sample. This technique helps determine the type and characteristics of cells present in the fibrous dermatofibroma, aiding in accurate diagnosis.
- Excisional Biopsy: In some cases, a complete excisional biopsy may be performed to remove the entire lesion. This approach is typically chosen when the lesion is small or when a definitive diagnosis is required. The excised tissue is then sent for histopathological examination.
- Incisional Biopsy: An incisional biopsy involves removing a portion of the lesion for examination. This technique is commonly used when the lesion is large or difficult to remove in its entirety. The sampled tissue is analyzed to confirm the diagnosis of fibrous dermatofibroma.
- Fine Needle Aspiration: Fine needle aspiration involves using a thin needle to extract a small amount of tissue or fluid from the lesion. This technique helps evaluate the cellular content and assists in ruling out other conditions with similar presentations.
- Ultrasonography : Ultrasonography uses high-frequency sound waves to create images of the lesion’s internal structures. It helps determine the lesion’s depth, size, and any underlying abnormalities, providing additional information for diagnosis.
- Magnetic Resonance Imaging: MRI utilizes powerful magnets and radio waves to produce detailed images of the affected area. It helps evaluate the extent of deeper tissue involvement and assists in differentiating fibrous dermatofibroma from other lesions.
- Computerized Tomography (CT) Scan: A CT scan combines X-rays and computer technology to create cross-sectional images of the body. It helps visualize the lesion’s internal structures and determines if it has spread to nearby tissues or organs
Treatment
Fibrous dermatofibroma treatment
Non-Surgical Treatments
- Topical Steroids: Topical steroid creams or ointments can help reduce inflammation and alleviate symptoms associated with fibrous dermatofibroma. These medications are applied directly to the affected area and are particularly useful for managing itching and redness.
- Cryotherapy: Cryotherapy involves freezing the dermatofibroma using liquid nitrogen. This treatment causes the lesion to blister and eventually fall off. Cryotherapy is a quick and relatively painless procedure, often leaving behind minimal scarring.
- Laser Therapy: Laser therapy employs targeted beams of light to destroy the fibrous dermatofibroma. It is particularly effective for small lesions and can significantly improve the appearance of the skin. Multiple sessions may be required for optimal results.
- Intralesional Steroid Injections: Intralesional steroid injections involve injecting a corticosteroid medication directly into the dermatofibroma. This treatment helps shrink the lesion and reduce symptoms. It is commonly used when other treatments have failed or for larger, more bothersome lesions.
- Retinoid Creams: Topical retinoid creams, derived from vitamin A, can be used to treat fibrous dermatofibroma. They work by reducing cell proliferation and promoting normal skin cell turnover. Regular use can lead to a smoother, less noticeable lesion.
- Imiquimod Cream: By stimulating the immune system, this topical cream helps the body eliminate the dermatofibroma.
- Interferon Injections: These injections boost the immune system’s response to the dermatofibroma, leading to its regression.
- Oral Medications: Prescription medications like tamoxifen, imatinib, or methotrexate may be prescribed in severe or recurrent cases.
- Herbal Remedies: Some herbal supplements, such as green tea extract, turmeric, or aloe vera, are believed to have anti-inflammatory and antioxidant properties that can help manage fibrous dermatofibroma symptoms.
- Acupuncture: This traditional Chinese medicine technique involves inserting thin needles into specific points to stimulate the body’s natural healing process.
- Homeopathic Treatments: Certain homeopathic remedies, such as Thuja occidentalis or Silicea, are believed to have a positive impact on fibrous dermatofibroma.
Surgical Treatments
- Excisional Surgery: Excisional surgery involves surgically removing the entire dermatofibroma. This procedure is often performed under local anesthesia and may require stitches to close the wound. Excisional surgery provides complete removal of the lesion but may result in a small scar.
- Shave Excision: Shave excision involves using a blade to shave off the elevated part of the dermatofibroma. This technique is suitable for superficial lesions and typically leaves a smaller scar compared to excisional surgery.
- Punch Excision: Punch excision utilizes a small circular blade to remove the entire dermatofibroma, including the underlying tissue. The resulting wound is closed with sutures or left to heal naturally. Punch excision is often chosen for smaller lesions and can produce favorable cosmetic outcomes.
- Mohs Micrographic Surgery: Mohs surgery is a precise technique used for larger or recurrent dermatofibromas. The tumor is removed layer by layer, and each layer is examined microscopically to ensure complete excision while preserving healthy tissue. This method has a high success rate and minimizes scarring.
- Laser Surgery: Laser surgery involves using a focused laser beam to vaporize or remove the dermatofibroma. This procedure is precise and allows for bloodless removal while minimizing damage to surrounding tissue. Laser surgery is often preferred for facial lesions or areas requiring meticulous attention.
- Punch Excision: A small, circular tool is used to cut out the dermatofibroma, which is then stitched or left to heal naturally.
- Curettage and electrodessication: The dermatofibroma is scraped off and the remaining tissue is burned using an electric current.
- Carbon Dioxide Laser Surgery: A laser beam is used to vaporize the dermatofibroma layer by layer, leaving minimal scarring.
- Shave Excision: The dermatofibroma is shaved off the skin’s surface, but it may have a higher recurrence rate compared to other surgical methods.
- Radiofrequency Ablation: Radiofrequency energy is used to heat and destroy the dermatofibroma, resulting in its gradual disappearance.
Other Treatment Options
- Electrodesiccation and Curettage: Electrodesiccation and curettage is a two-step procedure involving scraping the tumor with a curette (a spoon-shaped instrument) and then cauterizing the area with an electric current. This treatment effectively removes the lesion but may cause scarring.
- Topical Medications: Certain topical medications, such as corticosteroids, retinoids, or imiquimod cream, may be prescribed to manage fibrous dermatofibromas. These medications can help reduce inflammation, soften growth, and promote gradual regression. They are typically recommended for smaller or less symptomatic growths.
- Intralesional Steroid Injections: Intralesional steroid injections involve the direct administration of corticosteroids into the fibrous dermatofibroma. This treatment option aims to shrink the growth and alleviate associated symptoms. Multiple injections may be required over several weeks or months.
- Radiation Therapy: Radiation therapy utilizes high-energy radiation beams to destroy the fibrous dermatofibroma cells. This treatment option is generally reserved for larger or recurrent growths that have not responded well to others
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