A 27-year-old African American man presents for evaluation of painful “bumps” on his right arm. He explains that they are more painful in cold weather. Physical examination reveals numerous, flesh-colored to hyperpigmented rubbery nodules ranging in size from 0.4 cm to 1.0 cm on the proximal lateral right arm. He states that his father was afflicted with a similar condition.
Submit your diagnosis to see full explanation.
Piloleiomyomas are benign lesions that develop in the arrector pili muscle of the skin. The lesions are firm, red to brown nodules that may appear in a linear or dermatomal pattern.1 The lesions are most common on the upper body and trunk. Equal incidence is found in males and females, with the disorder typically manifesting by the fifth decade of life.2
Piloleiomyomas are characteristically painful. The pain can occur spontaneously or in response to cold or touch. Differential diagnosis includes other lesions that may be accompanied by pain, including angiolipomas, dermatofibromas, and glomus tumors.3 Multiple lesions may be associated with uterine fibroids and renal cell carcinoma. Termed Reed syndrome, the condition is caused by mutations in a tumor suppressor gene.4 Treatment is influenced by location, size, and number of lesions. Incomplete surgical excision will result in recurrence. Oral medications such as calcium channel blockers, phenoxybenzamine, and gabapentin may lessen the pain associated with lesions.3 Carbon dioxide laser and intralesional triamcinolone acetonide may also decrease pain.3,5
Rebecca Geiger, PA-C, is a physician assistant on staff at the DermDox Dermatology Center in Hazleton, Pennsylvania. Stephen Schleicher, MD, is an associate professor of medicine at the Commonwealth Medical College in Scranton, Pennsylvania, and an adjunct assistant professor of dermatology at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia.
- Kim H, Park I, Koh J, Kang J, Seo J, Seol J, et al. Multiple piloleiomyomas treated with suction-assisted cartilage shaver. J Am Acad Dermatol. 2013;68(Suppl 1):AB221.
- Heng J, Choi E, Tan K, Chen We Aw D. Characteristics of cutaneous leiomyomas in a tertiary hospital. J Am Acad Dermatol. 2016;74(Suppl 1):AB48.
- Nutan F. Leiomyoma. http://emedicine.medscape.com/article/1057733-overview. Updated December 6, 2016. Accessed November 1, 2017.
- Patel VM, Handler MZ, Schwartz RA, Lambert WC. Hereditary leiomyomatosis and renal cell cancer syndrome: An update and review. J Am Acad Dermatol. 2017;77:149-158.
- Liu C, Tang ZH, Bei H, Zeng HY. Treatment of a patient with multiple cutaneous piloleiomyoma-related pain with a local injection of triamcinolone acetonide. Dermatology. 2013;227:52-54.