Periungual fibroma, also known as Koenen’s tumor, is a benign fibrous nodule that forms on the periungual region of the fingers or toes. This condition is considered a type of soft tissue tumor, which is a growth of abnormal cells in the soft tissue of the body.
Periungual fibroma is a relatively uncommon condition, affecting only a small percentage of the population. It is most commonly seen in children and young adults, with a higher incidence in males than females. The exact cause of periungual fibroma is unknown, but it is believed to be related to a genetic predisposition or a traumatic injury to the affected area.
The main characteristics of periungual fibroma include a small, firm, smooth, dome-shaped nodule that is usually less than 1 cm in diameter. The nodule is usually located on the periungual region of the finger or toe, and may be flesh-colored, pink, or brown. The affected area is often tender to the touch and may be painful, especially when pressure is applied to it.
Causes
Periungual fibromas are usually harmless and do not cause any discomfort or pain, but they can be unsightly, especially for individuals who take pride in their appearance.
The exact cause of periungual fibroma is not known, but there are several theories and factors that have been linked to its development. These include genetics, trauma, and conditions that affect the skin and connective tissue, such as tuberous sclerosis and neurofibromatosis type 1.
- Genetics
One of the main theories regarding the cause of periungual fibroma is genetics. Studies have shown that periungual fibroma can run in families, suggesting that there may be a genetic predisposition for its development. However, the specific genetic mutations that contribute to periungual fibroma are not yet known.
- Trauma
Trauma is another theory that has been linked to the development of periungual fibroma. It is believed that repetitive or continuous injury to the nail matrix can cause the tissue to become fibrotic and form a fibroma. This theory is supported by the fact that periungual fibroma is more commonly found in individuals who engage in manual labor or who frequently participate in activities that put pressure on the nails, such as playing musical instruments.
- Tuberous Sclerosis
Tuberous sclerosis is a genetic condition that causes benign tumors to develop in various parts of the body, including the skin and connective tissue. Periungual fibroma is one of the common skin lesions associated with tuberous sclerosis. In individuals with this condition, the fibromas may be more numerous and occur at an earlier age.
- Neurofibromatosis Type 1
Neurofibromatosis type 1 is another genetic condition that is associated with the development of periungual fibroma. This condition is characterized by the growth of benign tumors along the nerves and in other parts of the body, including the skin. In individuals with neurofibromatosis type 1, periungual fibromas may be more numerous and may occur in combination with other skin lesions.
- Other Factors
In addition to the above-mentioned theories, there are other factors that have been linked to the development of periungual fibroma. These include hormonal changes, such as pregnancy, and exposure to chemicals, such as formaldehyde. However, the role of these factors in the development of periungual fibroma is not well understood and further research is needed to determine their impact.
Symptoms
The symptoms of periungual fibroma are usually cosmetic in nature and do not cause any pain or discomfort. However, the appearance of these tumors can be unsightly and can impact an individual’s self-esteem. In this article, we will discuss the main symptoms of periungual fibroma.
- Nodules: The most common and easily recognizable symptom of periungual fibroma is the presence of small, firm nodules around the nails. These nodules are typically round or oval in shape and can range in size from a few millimeters to a few centimeters. They can be skin-colored, pink, or slightly reddish in color and are usually smooth and firm to the touch.
- Location: Periungual fibromas are typically found around the nails on the fingertips, especially around the cuticles or the proximal nail fold. They can also occur on the toenails, but are less common in this location. In some cases, multiple fibromas may occur on the same hand or foot.
- Nail deformities: In some cases, periungual fibromas can cause deformities of the nails, such as ridging, pitting, or thickening. This can result in changes to the appearance of the nails and can be unsightly for some individuals.
- Pain or discomfort: Periungual fibromas are typically painless and do not cause any discomfort. However, in some cases, the fibromas may become irritated or infected, leading to pain or discomfort.
- Nail dystrophy: In some cases, periungual fibromas can lead to changes in the appearance of the nails, including nail dystrophy, which is characterized by changes in the shape, texture, and thickness of the nails. This can result in the nails becoming brittle, ridged, or deformed.
- Progression: Periungual fibromas are benign tumors, meaning that they do not spread to other parts of the body and do not become malignant. However, in some cases, multiple fibromas may develop over time, leading to a progressive increase in the number of nodules around the nails.
- Family history: In some cases, periungual fibromas may have a genetic component and may run in families. If a family member has been diagnosed with periungual fibromas, it is possible that other family members may also develop the condition
Diagnosis
Diagnosis of periungual fibroma can be done by a physical examination, and in some cases, additional tests may be performed to confirm the diagnosis. The main diagnostic tests for periungual fibroma are discussed below.
Physical Examination:
A physical examination is the first step in diagnosing periungual fibroma. The doctor will examine the lesion and take note of its size, shape, color, and location. They may also perform a biopsy of the lesion to determine its composition. The biopsy involves removing a small piece of the lesion for laboratory analysis.
Dermatoscopy:
Dermatoscopy is a diagnostic tool that allows the doctor to examine the lesion more closely. It is a non-invasive procedure that involves using a special magnifying lens to examine the lesion. The dermatologist can see the texture and structure of the lesion and determine if it is a fibroma or another type of skin lesion.
Biopsy:
A biopsy is a diagnostic test that involves removing a small piece of the lesion for laboratory analysis. The biopsy can help determine the composition of the lesion and confirm the diagnosis of periungual fibroma. The biopsy may be performed using a local anesthetic, and the results are usually available within a few days.
Histopathology:
Histopathology is a diagnostic test that involves examining the tissue under a microscope. The tissue sample is examined for signs of abnormal growth, such as the presence of fibrous tissue, to confirm the diagnosis of periungual fibroma. The results of the histopathology are usually available within a few days.
Immunohistochemistry:
Immunohistochemistry is a diagnostic test that involves using antibodies to detect specific proteins in the tissue sample. This test can help to confirm the diagnosis of periungual fibroma and determine the type of fibroma present.
Molecular Tests:
Molecular tests are diagnostic tests that use DNA or RNA to identify specific genetic mutations or changes. These tests can help to confirm the diagnosis of periungual fibroma and determine the type of fibroma present.
Treatment
The treatment of periungual fibroma depends on the size, location, and severity of the growth. The following are the main treatments for periungual fibroma:
- Surgical excision:
Surgical excision is the most common treatment for periungual fibroma. The procedure involves removing the growth with a scalpel or a laser. The procedure is usually performed under local anesthesia and is considered safe and effective. The procedure is relatively simple and involves removing the fibroma and some of the surrounding tissue to prevent recurrence. The healing process can take several weeks, and the patient may need to keep the affected area protected and covered with a bandage.
- Cryotherapy:
Cryotherapy is a treatment that involves freezing the fibroma with liquid nitrogen. This procedure is considered safe and effective, and the patient may experience some pain and swelling after the procedure. Cryotherapy is a good option for smaller fibromas and is considered less invasive than surgical excision.
- Electrodessication and curettage (EDC):
EDC is a procedure that involves removing the fibroma by scraping it off with a curette and destroying the base with an electric current. This procedure is usually performed under local anesthesia and is considered safe and effective. The procedure is relatively simple and can be performed in the doctor’s office. The patient may experience some pain and swelling after the procedure, and the affected area may need to be covered with a bandage.
- Steroid injections:
Steroid injections are a treatment option for periungual fibroma. The injection involves injecting a steroid into the growth to reduce inflammation and shrink the fibroma. The procedure is usually performed under local anesthesia and is considered safe and effective. The patient may experience some pain and swelling after the procedure, and the affected area may need to be covered with a bandage.
- Topical medications:
Topical medications are a treatment option for periungual fibroma. Topical medications are creams or gels that are applied to the skin to reduce inflammation and shrink the fibroma. The medications may contain steroids, retinoids, or other active ingredients. The patient may experience some redness and skin irritation after applying the medication, and the affected area may need to be covered with a bandage.
- Laser therapy:
Laser therapy is a treatment option for periungual fibroma. Laser therapy uses a high-intensity light to destroy the fibroma and prevent it from growing back. The procedure is usually performed under local anesthesia and is considered safe and effective. The patient may experience some pain and swelling after the procedure, and the affected area may need to be covered with a bandage.
- Radiotherapy:
Radiotherapy is a treatment option for periungual fibroma. Radiotherapy uses high-energy radiation to destroy the fibroma and prevent it from growing back. The procedure is usually performed in a hospital or outpatient facility, and the patient may need to undergo several treatments over several weeks. Radiotherapy is considered safe and effective, but the patient may experience some skin irritation and redness after the procedure.