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Has anyone seen these lesions?

Discussion in 'General Issues and Discussion Forum' started by Simone Lee, Feb 5, 2013.

  1. Simone Lee

    Simone Lee Active Member

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    Hi everyone, I should probably know this and may have learnt it at uni, but that was a long while ago.

    Can anyone identify these lesions please? They appear verruca like but wasnt sure.

    Attached Files:

  2. Greg Fyfe

    Greg Fyfe Active Member


    I have seen something like that, quite a few years back now, to my eye not what I expect a plantar wart to usually look like. Possibly some variant or a "flat " wart. Possibly something else...

    I didn't find out what I was looking at, there's certainly some rare conditions out there and I suppose theres always a possibility it could be something rare.

    I've included a link to NZ Derm net, which I find a handy reference


    Possibly a GP specialising in skin or a dermatologist could provide more info' examining them with a dermoscope.


    Last edited: Mar 12, 2013
  3. blinda

    blinda MVP

    Hi Simone,

    Bit more of a history would be grand;

    Age, meds, familial hx, onset and description of lesions, ie do they hurt, itch etc? Any palmer/plantar involvement? Does the pt fall within the CREST syndrome?

    Could be punctate keratoderma, which can be autosomal, but impossible to say without more detail.

  4. Mike Plank

    Mike Plank Active Member

    I saw some similar lesions that turned out to be scars from standing on a sea urchin. Questioning patient at length and good history taking is essential to diagnosis.
  5. blinda

    blinda MVP

    Indeed. I always take med hx and often ask the pt to describe symptoms before they remove their footwear. Removes majority of red herrings.
  6. clairoo

    clairoo Member

    looks a little like the beginnings of pitted keratosis but i think dermatology referral needed.
  7. blinda

    blinda MVP

    With respect, clairoo, if I were to refer this to the dermatology dept without a list of differential diagnosis deduced from history taking, they would simply throw it back at me and I would lose the respect earned as a health professional. Nowadays, any referral to an NHS dept for further investigation has to be justified.

  8. clairoo

    clairoo Member

    Hi Blinda
    Apologies for my previous quick reply I was just checking the arena between patients, obviously I would always reccommend taking a detailed medical history, presentation, signs and symptoms etc before making a diagnosis or referring on, I was taking that part as a standard/given. I do think the lesions look a little like a mild pitted keratosis...anyway back to the patients apologies again,
  9. clairoo

    clairoo Member

    Me again, I should have said, pitted keratosis would be one of my a differential diagnosis.
  10. blinda

    blinda MVP

    No need to apologise! I`m just big on thorough assessment before arriving at any definative dx. With the information provided, thus far, the lesions could be one of many conditions.

    Personally, I only refer pts to dermatology if the lesion is suspicious of malignancy so requires dermoscopy and/or biopsy or is interfereing with the pts QOL. They really don`t appreciate referrals of benign lesions.

    Out of interest, did you mean pitted keratolysis or punctate keratoderma (PPK)? Two very different beasts.

    Cheers :drinks (take a penny off yer pint!)
  11. clairoo

    clairoo Member

    I mean pitted keratolysis, to be honest my husband has a pretty bad case of it... anyway it has improved with home treatments ( tea tree oil soaks ) but I have made an appointment for him at GP re systemic antibiotics/topical antiobiotics. I shall try and take some pics of his feet and post them later. Anyway will see what I can do,
  12. blinda

    blinda MVP

    Oxidised Tea Tree Oil probably would destroy bacterium, then again so would Domestos ;)

    Actually, that would make a good case study, clairoo (not with domestos, obviously). Could you start a new thread in the "General Issues `n Discussion" forum, as many posters don`t visit "Dermatology lastest news".

    Look forward to seeing the pics!

    Last edited: Mar 20, 2013
  13. Pacifico

    Pacifico Member


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