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Dermatofibromas are benign skin growths that usually develop gradually, often appearing as a single nodule, most frequently on an extremity such as the lower leg, though they can occur anywhere on the skin. Typically, these nodules are painless; however, they can be a source of discomfort, with itching and pain being common complaints. Notably, dermatofibromas are among the most frequently painful skin lesions. Females who shave their legs might experience pain and bleeding due to razor trauma to the nodule, which can lead to erosive changes and ulceration. While there are rare instances of rapid growth, the majority of dermatofibromas remain unchanged for many years or are persistent.
Patients often describe these nodules as hard moles or atypical scars and may express concerns about the risk of skin cancer. Although multiple lesions can occur, the presence of numerous (15 or more) tumors is quite rare, affecting less than 1% of patients. Approximately 60% of these patients have an associated systemic condition, such as HIV infection or systemic lupus erythematosus.
Association with Systemic Conditions
The phenomenon of multiple eruptive dermatofibromas has been documented in conjunction with a variety of systemic conditions, including but not limited to dermatomyositis, Graves disease, Hashimoto thyroiditis, myasthenia gravis, Down syndrome, leukemia, myelodysplastic syndrome, cutaneous T-cell lymphoma, multiple myeloma, atopic dermatitis, Crohn's disease, ulcerative colitis, sarcoidosis, and during pregnancy. Additionally, certain medications, such as antiretroviral agents, efalizumab, brentuximab vedotin, antitumor necrosis factor-alpha agents, and the tyrosine kinase inhibitor imatinib, have been correlated with the development of dermatofibromas.
Congenital and Acquired Cases
There have been reports of both congenital and acquired multiple clustered dermatofibromas. These cases add to the diverse clinical presentation of dermatofibromas and emphasize the importance of considering a wide range of factors when evaluating these skin lesions.
In summary, dermatofibromas present a variety of clinical manifestations, from solitary nodules to multiple lesions associated with systemic conditions or medication use. While they are generally benign, their presence can cause discomfort and may prompt concerns about skin cancer. Understanding the clinical spectrum of dermatofibromas is crucial for accurate diagnosis and patient reassurance.
