Papules are palpable inflamed lesions, which vary in size, firmness and redness.  Fifty per cent of papules arise from normal-looking skin7 which could have been the site of a microcomedone, while 25 per cent arise from a whitehead  and 25 per cent from a blackhead. Two types of papules are recognized - the active and the less active . Less active papules  are less red and smaller than the active lesions, which  may  reach  a  diameter of 4 mm, and which last longer. Of the less  active papules, 7 per cent resolve directly via a macule; the others develop into an active papule or pustule. Figure 3.15 shows the complex interrelationship between inflamed lesions. Very occasionally, close examination of an early papule may reveal a slight erythematous flare 5-10 mm in diameter around the developing  lesion, which may persist for 1-3 hours. The involved area is slightly uncomfortable with minimal tenderness.

An active papule may resolve directly to a macule or indirectly via a less active papule. Occasionally other patterns are seen.