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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.
Cheers

 

Hi

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

http://www.dermnetnz.org/sitemap.html#f

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

Regards

Greg

 

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.

Cheers,
Bel

 

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.

 

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

 

Hiya,
looks a little like the beginnings of pitted keratosis but i think dermatology referral needed.
:0)

 

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.

Cheers,
Bel

 

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,
Claire

 

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

 

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!)
Bel

 

Hiya,
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,
c

 

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!

Cheers,
Bel

 

http://emedicine.medscape.com/article/1053078-overview