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DISORDERS OF FASCIA

Fascial diseases are not particularly the province of the dermatologist. Some of the inflammatory causes of fasciitis are more likely to present to rheumatologists or orthopedic surgeons, although eosinophilic fasciitis can present to dermatologists (and is discussed in Ch.11). Dupuytren contracture is a relatively common, sometimes familial, type of (usually palmar) fibromatosis, which has fairly characteristic features (Fig. 22.54). Treatment, if required, is surgical, but it is not generally managed by dermatologists and is not discussed further.

Figure 22.54 Dupuytren contracture is a clinically characteristic fascial fibromatosis. On the hand, it presents as a gradually progressive flexion contracture of the ring and little fingers.

    Defects in the fascia may cause herniation of deeper tissues and may be seen by dermatologists due to the clinical appearance of a subcutaneous nodule.

Fascial defects and piezogenic pedal papules

Herniation through fascial defects (Fig.22.55) is a similar process to anetoderma in some respects, but without skin atrophy, as the overlying dermis is normal. This may occur over the anterior tibia, but is often not brought to medical attention or may be diagnosed as a protruberant vein.

Figure 22.55 Fascial defect on the anterolateral leg, with deeper herniation. This disorder is not uncommon.

Figure 22.56 Piezogenic pedal papules. Pale, compressible nodules at the border of the foot. These may be painful in some cases, but are usually an incidental finding, or patients may be referred because of an uncertain diagnosis. They are typically made more apparent by standing and may disappear when lying flat.

    Piezogenic pedal papules are clinically characteristic lesions that are usually most apparent at the medial border of the heel. They represent small fatty herniations through fascial defects, producing pale or skin-colored compressible nodules (Fig.22.56). They may be asymptomatic, but some patients complain of pain. They are often confused with warts, even though they have no epidermal component. The simplest treatment, if required, is support hosiery.

White/Cox: Diseases of the Skin, 2ed.(c) 2006, Elsevier Inc. All rights reserved.