title: A nonsurgical approach to painful piezogenic pedal papules.
abstract: For more than 3 decades, piezogenic pedal papules have been described in the literature. While many individuals with these papules are asymptomatic, patients with trauma or connective tissue diseases can experience pain. In our case study, we describe a unique, nonsurgical approach that abates the pain of painful piezogenic pedal papule (PPPP). Three injections of a solution of equal parts betamethasone (Celestone) and bupivacaine (Marcaine) were curative in a male patient with Ehlers-Danlos syndrome type III with PPPP. In addition, combination steroid/anesthetic injection provides another method of treatment in the management of PPPP.
authors.affiliation: Department of Family Practice and Community Medicine, University of Pennsylvania, Philadelphia 19104-4283, USA. ddoukas@mail.med.upenn.edu
authors.forename: David J
authors.initials: DJ
authors.lastname: Doukas
authors.forename: James
authors.initials: J
authors.lastname: Holmes
authors.forename: James A
authors.initials: JA
authors.lastname: Leonard
mesh_terms: D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D001623:Betamethasone / Q000008:administration & dosage / Q000627:therapeutic use*; D002045:Bupivacaine / Q000008:administration & dosage / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D004535:Ehlers-Danlos Syndrome / Q000150:complications; D005534:Foot Diseases / Q000150:complications / Q000188:drug therapy*; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006365:Heel / Q000473:pathology; D006547:Hernia / Q000150:complications / Q000188:drug therapy; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D010146:Pain / Q000188:drug therapy* / Q000209:etiology
chemical_list: D000779:Anesthetics, Local; D005938:Glucocorticoids; D001623:Betamethasone; D002045:Bupivacaine