简单病例

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Case 13

32-year-old man presents with new lesions on right foot.

I noticed them 2 months ago.

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No, I feel great.

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Yes, they hurt when I walk.

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My father died from skin cancer.

Could the disease be infectious or genetic?

No, I was always healthy.

Could it be a recurrent disease?

I am a construction worker and have been wearing heavy rubber boots for the past 4 months. Everyone sweats a lot in them.

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Choose the right efflorescences:

False. The lesions are raised but not smooth.

A crust consisted on dried blood, pus or serum. This is not present here.

Urticaria is transient.

Once again, a raised lesion, but not smooth. Furthermore a nodule is >5mm.

Correct. We see localized massive exophytic hyperkeratosis.

Choose the right diagnosis:

Hyperkeratotic lesions can be seen in the perianal region in syphilis but not on the back of the foot.

Scabies is pruritic, with papules, excoriations and a different distribution pattern.

A melanocytic nevus is usually pigmented and does not have excessive scale.

The lesions do not have peripheral scale and erythema, as is typical for tinea.

Correct. These are typical common warts (verrucae vulgares) caused by human papilloma virus infection.

Choose the right therapy(ies):

Warts are diagnosed clinically. Biopsy is only appropriate in confusing cases.

While 50% of warts disappear in 2 years, this patient is having pain and deserves treatment.

Contraindicated. While radiation therapy was used decades ago for resistant warts, it is no longer acceptable.

No need for an x-ray and surely no need for toxic systemic treatment.

This is the usual first approach for a limited number of warts.

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