Papules (Skin Lesions) in Eczema

Atopic dermatitis (commonly called eczema) causes many changes to the skin. It can cause color changes, rashes, itching, scarring, and other symptoms. One common feature of actively inflamed areas of eczema are papules.¹

What are papules?

A papule is a raised skin lesion less than 1 centimeter big (in diameter). A macule is a flat skin lesion less than 1 centimeter in diameter. Many common rashes are described as being maculopapular. This means they have a mix of small flat and raised skin changes.²

Papules often occur in areas of inflammation. They are usually not filled with fluid or pus. They may contain skin cells or clogged hair follicles. Some types of acne bumps are described as papules. Skin changes or rashes that have papules can also occur along with:²

• Allergic reactions
• Infections
• Conditions related to the immune system, like eczema

Papules can be a variety of different colors. Some examples are red, pink, purple, or brown. On lighter skin colors, they are more likely to be red or pink with surrounding redness. This redness can be harder to see on darker skin tones. Purple or brown papules may be the first or only sign of eczema on darker skin tones.^3,4

When papules are bigger than 1 centimeter, they are called plaques or nodules.²

Why do papules occur with eczema?

Areas of active eczema may have maculopapular skin changes. They are caused by a weakened skin barrier and an overactive immune system. Acute, or short-term, areas of eczema are more likely to have papules. Long-term, or chronic, areas of eczema may instead have skin thickening and plaques due to scratching over time.¹

Tiny papules on the skin around hair follicles called keratosis pilaris are also common in people with eczema. These can be present even in areas that are not actively inflamed. They often appear on the backs of the arms.^1,5

How are papules treated?

Since papules are usually a sign of inflammation and can come with eczema flares, preventing flares is important. Here are some common ways to prevent flares:^3,4,6,7

• Use moisturizer regularly.
• Take over-the-counter allergy drugs like Benadryl to help with itching.
• Keep inflamed areas clean with non-irritating soap and water.
• Cover any inflamed areas with emollients and bandages as instructed by your doctor.
• Avoid popping any noticeable papules.
• Take or use all eczema treatments exactly as your doctor prescribes them.
• Reduce stress as much as possible to prevent future flares.
• Avoid known eczema triggers in the environment or in food.

If you have a flare-up with many new papules, your doctor may prescribe creams or drugs that will slow down your immune system. These may include oral steroids or targeted therapies like dupilumab.⁶

People with eczema are at an increased risk of developing skin infections in areas where the skin is broken down or inflamed. Papules can be a sign of these infections. Some viral infections, like herpes simplex virus (HSV) can spread quickly and become dangerous in people with eczema. This infection is called eczema herpeticum.^1,7

If you notice new papules or a worsening of existing papules, call your doctor. They can help determine if these are related to eczema or another underlying issue.