Leiomyomas: Symptoms, Characteristics and Treatments

What are they?

They are benign tumors of soft tissues that are derived from smooth muscle. These lesions may develop in the smooth muscle, but malignant transformation probably does not occur.

Signs and symptoms

The most common feature in patients with multiple piloleiomyomas (cutaneous leiomyomas) is pain, which may be spontaneous or induced by pressure (for example, cold stimuli) or tactile pain.

Pain or sensitivity may also be secondary to pressure on the nerve fibers within the tumor; however, it can only be a product of the contraction of muscle fibers.

Also, due to the symptoms that occur with menstruation or pregnancy.


The characteristics of individual piloleiomyomas include Smooth, firm papules or nodules—usually less than 2 cm in diameter, reddish-brown, and sensitive to palpation.

They are usually found in a lower extremity, fixed in the skin, but can quickly move through the deep subcutaneous tissues.


Multiple Piloleiomyomas can occur on the face, trunk, or limbs.

Leiomyomas of the vulva or scrotum may be larger than those described above. Nipple leiomyomas and piloleiomyomas are generally similar in size.


Laboratory tests are usually unnecessary to evaluate leiomyomas unless there is abnormal vaginal bleeding or to rule out other conditions.

The measurement of hemoglobin and hematocrit levels can be considered in patients with multiple leiomyomas.

Image studies

Imaging studies are not performed routinely for leiomyomas; However, angioleiomyomas have a characteristic ultrasound and magnetic resonance imaging findings.

Uterine leiomyomas (also called fibroids ) can be evaluated by Doppler ultrasound before uterine arterial embolization.


A tissue examination is necessary to establish the diagnosis. Therefore, a biopsy or partial excision is indicated.


All leiomyomas are tumors; Therefore, medical treatment has a limited role in resolving or destroying these injuries. However, pharmacological intervention can alleviate the associated pain.


The following medications are used in women with leiomyomas, mainly for analgesia:

  • Alpha-adrenergic blocking agents (e.g., phenoxybenzamine)
  • Calcium channel blockers (for example, nifedipine)
  • Anticonvulsants (for example, gabapentin)

Surgical Option

Surgical excision or ablation of leiomyomas may be helpful for some symptomatic women.


Several researchers have reported that calcium channel blockers, especially nifedipine, relieve the pain associated with many cases of piloleiomyomas.

As the name implies, drugs of this class inhibit the movement of extracellular calcium ions through the cell membrane in the smooth muscle cell, which inhibits muscle contraction.

Phenoxybenzamine, an alpha-adrenergic blocker, is also helpful in relieving pain, including pain induced by cold, in some cases.

Gabapentin has also shown promise for alleviating the pain of piloleiomyomas.