Help with diagnosis of plantar skin condition

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Hi everyone.

I hope you can help me with a diagnosis. I haven’t been qualified very long and I’m worried that I may be missing something obvious, or may miss something serious.
:wacko:
My patient (Lady in her 40s) is concerned about an area on the plantar aspect 3/4th metatarsophalangeal joint area left foot which appears to be increasing in size. O/E the area is oval, 1cm high and 6mm across, very slightly raised. There is no hard callus over it, but there is some soft thickened skin there. Through the skin I can see 5 distinct pinhead sized white dots. Since the dermal striae are uninterrupted over this, I presumed they were seed corns and would ‘pop out’ during debridement. This didn’t happen, and the white areas just continue straight down like tubes. There was no bleeding even though I debrided quite a lot. The patient says that the area is not painful, but I squeezed the lesion as though testing a verruca and she did feel a sharp pain. Can a verruca present like this? I would be very grateful for some advice.
Thanks

 

Re: Help with diagnosis please

Hello
Any chance of a photo ??

If your really not sure, to refer on in the sensible thing to do but if you want an opinion, you have a very capable "dermy" pod in Winchester (Bel) who I'm sure would oblige.
Hope that helps
Cheers
Derek

 

Dear amw504,
Skins are frequently difficult. Best to refer for a specialist opinion to know what it is you are dealing with. I'd like to know what this condition turns out to be when you find out. Good luck.

 

Hi amw504;
i agree with Mr CW Kerans - if in doubt refer on! but i find this website (which you've probably seen already) really helpful http://www.dermnetnz.org/ and the images are really useful!
Another tip - (againyou probably know) take photos at each visit and accurate measurements and if its evolving definitely refer on to a specialist dermatologist.
Good luck - and if you find out what it was - let us know x

 

Hi
i agree with Mr CW Kerans too allways refer if you dont know or are unsure.
you could all ways ask some one more senior than your self two! i havent been qualified for very long and if i am unsure about any thing then i ask, even if it turns out to be nothing.
its better to be safe than sorry!
good luck