Difference Between Macule and Papule

What is Macule and Papule?

Both are skin conditions. Both are dermatological manifestations (skin problems) which occur in various local or systemic (something that is spread throughout) disease conditions.

However, macule is a non-elevated discolored skin patch on the skin and papule is an elevated white lesion that is smaller than 0.5cm in diameter.

What is Macule?

A small (usually < 1 cm in diameter) flat, non-palpable and altered in color – a discolored blemish or lesion that can be brown, tan, red or white and has same texture as surrounding skin.  

Macular rashes usually happen in following medical conditions

• Reactions due to some medications
• Inflammatory conditions like allergies
• Infections by viruses such as EBV (Epstein-Barr virus) and bacteria such as hepatitis

What is Papule?

It is an elevated, circumscribed solid cutaneous lesion that is up to 1 cm in size. It can be present in variety of colors like red brown, purple brown, brown, pink, and yellow brown.

It can occur on the face, often on the eyelids or alar rim, but also on the trunk and extremities. 

Difference between Macule and Papule

Definition

Macule

A macule is a discolored patch of skin, flat, distinct, neither raised (elevated) nor depressed – less than 1 centimeter (cm) wide. 

Macule doesn’t alter the texture and thickness of the skin. These blemishes or skin discoloration is caused by various causes. For example, macules could be vitiligo lesions (can be lighter or hypopigmented) or moles (that are darker in color or hyperpigmented).

Papule

Papules are cutaneous, circumscribed, inflamed blemishes sometimes and solid elevation of the skin, up to 1 cm in diameter. Papules are tiny lesions or dome-shaped elevations on the skin that are either red or pink colored and can be well seen on the skin. Papules have well-defined boundaries and usually occur on the face. Shapes of papules could be different. Sometimes these papules (elevated bumps on the skin) cluster together to form what appears like a rash and feels rough like sandpaper. Papules often start as erythematous macules.

Causes

Macule

Macules can be caused by various conditions that impact the way your skin color and texture look, leading to discolored areas. Conditions that are likely to cause macules are:

• Vitiligo (patches of skin losing their pigment)
• Moles (common non-cancerous skin growth usually dark brown triggered by clusters of pigmented cells)
• Freckles (tiny brown patches on your skin, usually in areas that get exposed to the sun)
• Sun spots, age spots, and liver spots
• Post-inflammatory hyperpigmentation (PIH) – dark spots left behind after a pimple heals such as that which appears after acne lesions heal
• Tinea versicolor (a common fungal infection of the skin)

Papule

The primary causes of papules (raised bumps or elevations on skin) in general, include:

• Too much oil production
• Bacterial infection
• Increased activity of male sexual hormones (androgens)
• Leishmaniasis
• Different forms of vasculitis

Acne (Papules) can also be triggered or aggravated by:

• Anxiety and stress
• Processed foods or diet, (consumption of too much sugar)
• Certain drugs like corticosteroids

Size

Macule

Flat papule <1 cm

Papule

Raised macule up to 1 cm

Etiology and layers of skin involved

Macule

Only dermis

Papule

Proliferation of cells in epidermis or superficial cells

Type of lesion

Macule

Flat area of altered color or texture

Papule

Elevated solid lesion

  Examples

Macule

Nevi, actinic keratoses, sun spots, age spots, warts, lichen planus, freckle, insect bites, liver spots, seborrheic keratoses, some lesions of acne, tinea versicolor, and skin cancers.

Papule

Warts, lichen planus, rash, insect bites, seborrheic keratoses, acne pimples or lesions, actinic keratoses, warts, bumps (white blood cells attacking an infection) and skin cancers.

Summary

The points of difference between Macule and Papule have been summarized as below:

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