Verrucous Plaques Research Articles

Solitary verrucous plaque on a leg.

We present the case of a female in her 70s who presented with a solitary verrucous plaque on her left leg accompanied by painful oral erosions. Various differential diagnoses were considered, like lichen simplex chronicus, hypertrophic lichen planus, and chromoblastomycosis. We diagnosed pemphigus vegetans (PVeg) on a nonintertriginous site through comprehensive clinical examination and histopathological and immunopathological evaluations. This case highlights the importance of considering PVeg in the differential diagnosis of solitary verrucous plaques, even in atypical extra-flexural anatomical locations.

Nevus Unius Lateris (NUL) in a Theree-Year-Old Child Treated by Tretinoin 0.025%, Desoxymethasone 0.25%, and Urea 20% Cream

Background: Linear verrucous epidermal nevus is the most frequent variant of the epidermal nevus classification. Linear verrucous epidermal nevus is characterized by the proliferation of epithelium arranged in a configuration that follows Blaschko's line. Nevus unius lateris (NUL) is a variant of the verrucous epidermal nevus, which has a unilateral distribution of lesions. Lesions are usually found at birth or in the first year of life as brown to grey verrucous papules or papillomatous plaques. The management of NUL is challenging as the results are varied and there is a high risk of recurrence. Purpose: to report a case of NUL and its management, especially in children. Case: A 3-year-old girl presented with brownish spots and multiple small lumps on the left buttock that have extended to the left leg since she was 9-days-old. On dermatologic examination, there were numerous hyperpigmented verrucous papules and plaques along the Blaschko line over the affected area. In this case, the diagnosis of NUL, is based on clinical symptoms and dermoscopy examination showed multiple large brown oval or round structures with hyperpigmented brown border. The patient was treated with combination topical therapy of tretinoin 0.025%, corticosteroid desoxymethasone 0.25%, and urea 20% cream, and the lesion improved within four weeks. Discussion: Epidermal nevus is often cosmetically disturbing. The treatment is still challenging and various, including surgical and non-surgical, but none is ideal and could potentially recur over months or years. dst.

Chronic cutaneous chromoblastomycosis: A rare case

Background: Chromoblastomycosis (CBM) is a rare, chronic granulomatous and suppurative skin infection classified as a subcutaneous mycosis. CBM has a poor prognosis with a low cure rate and a high recurrence rate. The lack of scientific data regarding the diagnosis and treatment of CBM also presents a challenge for clinicians in treating this disease. Appropriate therapy can increase the cure rate and prevent disease recurrence. Case Illustration: A 66-year-old woman presented with swelling in her left arm since the last 18 years due to wood-related injuries. There were multiple well-defined hyperkeratotic verrucous plaques, papules, and nodules, measuring 6-10 cm in diameter on the left antebrachial and hand regions. Some lesions were covered with erosion and crusts. The patient also had bone malformation. Histopathological examination showed typical characteristics of CBM. The patient was treated with 100 mg Itraconazole b.i.d. for 8 months. Discussion: Clinical manifestations and histopathological examination showed typical characteristics of CBM. Bone malformation occurred due to complications in chronic cases. Facility limitations led to the inability to perform direct microscopic examination using potassium hydroxide (KOH) and fungal culture on Sabouraud's dextrose agar. After 8 weeks of treatment, the patient's lesions were improved. The patient will be evaluated every month until treatment is complete to monitor the side effects of therapy. Conclusion: CBM lesions were improved after 8 weeks of treatment. Bone malformation could occur in chronic cases. It is important to diagnose CBM correctly and provide adequate therapy for a good outcome.

Verrucous plaque on the foot in a 12-year-old boy with epidermolysis bullosa.

Verrucous plaque on the foot in a 12-year-old boy with epidermolysis bullosa.

Brincidofovir for disease progression due to suspected tecovirimat resistance in association with advanced HIV.

A man with advanced HIV presented with verrucous plaques 2-3 months after initial mpox infection. He received two courses of tecovirimat without resolution of initial mpox lesions and development of new lesions raising concern for resistance. He was treated with two doses of brincidofovir and demonstrated improvement 6 months later.

Amelanotic melanoma masquerading as a plantar wart: A case report and review

A 69-year-old male presented with asymptomatic skin coloured, exophytic, verrucous plaque on right sole of three months duration. He had been diagnosed as a plantar wart and treated with chemical destructive methods. Biopsy from the lesion showed infiltrate of nests of atypical melanocytes extending upto reticular dermis. The malignant cells were positive for S100 and human melanin black 45(HMB 45) with a high MiB-1 proliferative index thus confirming diagnosis of amelanotic melanoma (AM). We report this case to highlight the atypical presentation of amelanotic melanoma, the possibility of misdiagnosis and the importance of immunohistochemistry in diagnosing the same.

Leprosy- Atypical Presentation with Reaction

Leprosy is a chronic granulomatous disease affecting mainly the skin and nerves caused by the obligate intracellular pathogen Mycobacterium leprae. Patient not always present with typical skin lesion with loss of sensation or muscle weakness rather may present with atypical skin lesion with swelling of the affected area like cellulites or lymphangitis as reactional state. A 25- years-old male patient presented with linear erythematous verrucous plaque along with multiple nodules and pain and swelling of left upper extremity. Local examination revealed sensory loss on inner aspect of left hand and finger and ulner nerve found enlarged, thickened and tender. Slit skin smear showed numerous lepra bacilli. Skin biopsy for histopathology showed collection of foamy histocytes forming granuloma within the upper dermis and wade fite staining, moderate number of lepra bacilli was seen. Patient was diagnosed as a case of borderline leprosy with type 1 lepra reaction. Patient was getting treatment with MDT (multi drug therapy) and systemic steroid and responded very well. His skin lesions are almost subsided and weakness of hand was recovering gradually. JAFMC Bangladesh. Vol 19, No 1 (June) 2023: 76-79

Solitary Ulcerated and Verrucous Plaque With Violaceous Borders: Answer.

Solitary Ulcerated and Verrucous Plaque With Violaceous Borders: Answer.

Solitary Ulcerated and Verrucous Plaque With Violaceous Borders: Challenge.

Solitary Ulcerated and Verrucous Plaque With Violaceous Borders: Challenge.

Utaneous verrucose phaeohyphomycosis due to Exophiala oligosperma in an immunocompetent host

ABSTRACT Herein, we report a case of subcutaneous infection caused by Exophiala oligosperma. A verrucous plaque was the major clinical feature. A histopathological examination revealed features of suppurative granuloma. Mycological and molecular identification revealed E. oligosperma as the etiologic agent. After eight months of treatment, the lesion showed worsening due to the use of self-medication with topical hydrocortisone. A second biopsy was performed with direct examination (KOH 10%) showing dark pigmented septate hyphae, yeast and multiple dark hyphae were highlighted in biopsy with Gomori methenamine silver (GMS) staining. We report this case to show the rise of this infection in an immunocompetent patient and the effects of steroids. The patient was treated with itraconazole and cryosurgery. Key words: Phaeohyphomycosis, Cutaneous, Verrucose, Exophiala oligosperma, Melanized fungi, Immunocompetent host, Itraconazole, Cryosurgery, Chromoblastomycosis

Kawasaki Disease Complicated with Giant Coronary Aneurysm in Case of Systematized Epidermal Nevus

Kawasaki disease (KD) is an acute systemic vasculitis that involves coronary arteries. Systematized epidermal nevus is a skin disease characterized by extensive verrucous and hyperchromic plaques. A male patient, previously diagnosed with systematized epidermal nevus, was referred for high fever. Eye injection, red lip, strawberry tongue, and enlarged neck node were accompanied. Intravenous immunoglobulin (IVGG) and high-dose aspirin were given for the treatment of KD. An echocardiogram revealed a small aneurysm in the right coronary artery (RCA). Second IVGG was administered because of refractoriness. The size of the aneurysm was increased to medium in RCA and another medium-sized aneurysm was found in the left anterior descending artery (LAD). Clopidogrel was added. After 3 days of defervescence, he was discharged. Warfarin was added for a giant aneurysm in LAD, aggravated 8 weeks later after the presentation. 11 months later, giant aneurysm was changed to medium sized aneurysm. Patient is at following with dual antiplatelet therapy without warfarin.

Lymphedema with dermatitis neglecta: a case rare report

Psychodermatology, an emerging field in dermatology, investigates the complex relationship between the skin and the mind. Dermatitis neglecta, a rare disorder, manifests as the accumulation of bacteria, perspiration, corneocytes, and sebum in a localised area of skin, leading to the development of a hyperpigmented patch or verrucous plaque. This case study presents dermatitis neglect, where the condition was triggered by a deliberate disregard for personal hygiene. Upon clinical examination, the patient presented with a hyperpigmented scaly patch, which was further confirmed through spirit testing. Alcohol swabbing can be used as a therapeutic and diagnostic approach for this particular case. The medical literature and textbooks provide scarce information on dermatitis neglecta, contributing to the limited understanding of this condition. Consequently, misdiagnosis is frequent, leading to unnecessary and aggressive diagnostic and therapeutic procedures. Dermatitis Neglecta is frequently misdiagnosed. Raising awareness of this condition is crucial in order to prevent unnecessary interventions. When required, emollients should be used judiciously, and appropriate patient education on maintaining personal hygiene and the application of keratolytics should be emphasized.

A case of chromoblastomycosis caused by Fonsecaea pedrosoi: challenge in diagnosis

Link of Video Abstract: https://youtu.be/9CxOCuDn4f4 Background: Chromoblastomycosis (CBM) is a chronic, granulomatous mycosis of the skin and subcutaneous tissue produced by the traumatic inoculation of various dematiaceous fungi. CBM lesions are clinically polymorphic and often misdiagnosed as multiple infectious and noninfectious diseases. Early diagnosis and prompt treatment of CBM are important to prevent further complications. This case study aims to evaluate the chromoblastomycosis caused by Fonsecaea pedrosoi as a challenge in diagnosis. Case Presentation: A male, 47 years old, came to the dermatovenereology clinic with a chief complaint of a wound on his right leg 17 years ago. The skin appeared thicker and scaly and felt rough. He also complained of pain and itch on the wound. Dermatological examination revealed multiple verrucous erythematous plaques, sized 10x20 cm, irregular with a well-defined and elevated border and black punctum. Results of potassium hydroxide, culture, and histopathology examination confirmed CBM with F. pedrosoi as the etiological agent. The patient was treated with a favorable outcome with oral itraconazole, local thermotherapy, and CO2 laser. Conclusion: The diagnosis of Chromoblastomycosis remains a challenge because lesions are clinically polymorphic and often misdiagnosed as various infectious and noninfectious diseases. Physicians should raise awareness of CBM as one of the differential diagnoses for chronic wounds. This case also showed that the combination treatment of itraconazole with adjuvant thermotherapy and CO2 laser had a favorable outcome.

Case Report: Leathery black plaque on the temple and scalp

Background Epidermal nevus sebaceous, commonly known as the nevus sebaceous of Jadassohn, is a congenital sebaceous hamartoma. It typically manifests as a single yellowish plaque across the head and neck and is composed of sebaceous glands. It commonly occurs during infancy and grows during puberty. Usually, it follows a benign course; however, in a few cases, it can be malignant. This is the case of a 13-year-old child with verrucous plaques on the temple and scalp. Case report We report the case of a 13-year-old boy with a steadily developing hyperpigmented verrucous plaque on the scalp and ipsilateral side of his face. A dermoscopic examination revealed ridges and fissures in a cerebriform pattern with yellowish-gray globules and a papillary appearance. Physical examination and laboratory tests revealed no abnormalities. Biopsies were taken from the scalp and temple area, and the findings were consistent with the diagnosis of nevus sebaceous. The patient was referred to a plastic surgeon for a staged excision. Conclusions We describe a unique example of a sebaceous nevus that affected the scalp and ipsilateral side of the face. As this hamartomatous growth carries the risk of cancer development, a dermatologist must identify the condition and begin treatment before malignant transformation occurs. This example of multiple verrucous plaques is an exception.

Rare Presentation of Chromoblastomycosis Due to Multiple Simultaneous Inoculations: A Case Report

Chronic infectious, granulomatous and suppurative dermatosis, classified among the subcutaneous mycoses, prevalent in tropical and subtropical regions and caused by the traumatic implantation of dematiaceous fungal species, where the presence of muriform bodies is an expression of the causal agent in the grafted tissue, are characteristic of chromoblastomycosis. Considered the second implantation mycosis in the world, it manifests itself with slow and progressive growth lesions of exophytic and verrucous plaques and black dots on the surface. The disease is considered a neglected and occupational disease, which occurs mainly among agricultural workers, coconut and babassu harvesters, lumberjacks, and traders of agricultural products. It is important to highlight that people at risk of contracting chromoblastomycosis work in tropical countries, where the temperature can be above 40 °C in summer, and generally refuse to wear protective equipment during the day (shoes, gloves, clothes, etc.), although they know that this type of prophylactic measure can prevent different types of diseases. These vulnerable people often live in low-income countries and sometimes live far from medical services and, once infected, do not seek medical attention. We report below an exuberant and unusual case due to multiple simultaneous inoculations on the back after the patient suffered an accidental fall while working on his farm. The diagnosis was established by direct mycological examination, histopathological examination, culture, microculture, and MALDI-TOF MS analysis that identified the agent of the Fonsecaea pedrosoi.

Epidermodysplasia Verruciformis: A Late Presentation

A 35-years-old female patient presented with multiple asymptomatic raised lesions of 4 years duration on the legs. Examination revealed multiple verrucous plaques over the two legs, size ranged from 0.5-1 cm, round to oval, with normal surrounding areas (Figure 1). Systemic examination was normal.

Athena: Specialty Certificate Examination case for infectious disease.

A 63-year-old man presented with an extensive pruritic and painful rash on his arm that had gradually progressed over 8 years after pricking his wrist on a bush, despite treatment with antifungals and antibiotics. Physical examination showed numerous erythematous, coalescing verrucous plaques in a sporotrichoid distribution on the arm with crust and scale. We discuss further tests, diagnosis and treatment.

DP12 Painful oral keratosis and skin lesions: a paraneoplastic diagnostic conundrum

Abstract A 70-year-old man was referred to oral medicine with extensive, painful oral hyperkeratosis affecting the tongue, buccal mucosa and palate. Medical history included a previous diagnosis of prostate cancer. Histology from multiple oral biopsy specimens showed only hyperparakeratosis and acanthosis, with no fungi or dysplasia. Owing to the absence of oral inflammation, the pain was treated as neuropathic. The patient then developed skin lesions and dermatology review was requested. Skin examination revealed marked hyperkeratotic, verrucous plaques affecting the extensor surfaces of the limbs and dorsal hands, as well as the plantar feet bilaterally. The nails were unaffected. There was violaceous discolouration of the pinnae. Given the history of prostate cancer, a paraneoplastic process was suspected. Two incisional biopsies were taken, which showed epidermal acanthosis with necrotic and dyskeratotic keratinocytes throughout the epidermis. There was a dense eosinophilic inflammatory infiltrate. Direct and indirect immunofluorescence was negative. The appearances were suggestive of a paraneoplastic phenomenon, including acrokeratosis paraneoplastica. Haematological investigations identified an IgG monoclonal paraproteinaemia with raised kappa:lambda ratio. Following further investigation, including bone marrow biopsy and positron emission tomography computed tomography, a diagnosis of monoclonal gammopathy of undetermined significance was made by haematology. A repeat bone marrow biopsy 7 months later confirmed evolution to myeloma. As CRAB criteria (hypercalcaemia, renal insufficiency, anaemia and bone lesions) were absent, a period of observation followed. A trial of oral steroids improved the cutaneous eruption, but he developed significant side-effects. Oral mycophenolate, methotrexate and acitretin were used as steroid-sparing agents, with a poor clinical response. The skin lesions progressed to a widespread psoriasiform eruption on the trunk and lower limbs with the formation of bullae. Further biopsies showed an eosinophil-rich infiltrate with negative immunofluorescence, raising the possibility of an eosinophilic dermatosis of haematological malignancy. After 2 years, given the worsening skin symptoms, it was decided to commence bortezomib, cyclophosphamide and dexamethasone (VCD) chemotherapy. Despite four cycles of VCD treatment, the skin lesions worsened and as the paraprotein levels did not reduce, treatment was stopped. Subsequently, further elevations in serum free light chains prompted treatment with lenalidomide. This resulted in a marked improvement in the skin and reduced pain from the oral lesions, as well as a reduction in serum free light chains. Acrokeratosis paraneoplastica (Bazex syndrome) is characterized by digital hyperkeratosis and paronychia, which may progress to involve the limbs and trunk. Eosinophilic dermatosis of haematological malignancy is characterized by a pruritic, papular skin eruption with a vesiculobullous component. This case presents a diagnostic conundrum, with evolving features of two different paraneoplastic conditions.

ORAL HAIRY LEUCOPLAKIA IN AN HIV-POSITIVE PATIENT: A CASE REPORT

Our clinic received a 33-year-old male patient, complaining of an oral burning sensation and white lesions on the lateral border of the tongue for 7 months. He also reported weight loss and nausea, and was recently diagnosed with HIV (viral load of 1,260,000 copies/ml and LTCD4 of 86 cells/uL). Intraoral exam showed white, verrucous, and irregular plaques located bilaterally on the tongue. An incisional biopsy was performed and anatomopathological examination showed superficial squamous epithelium with ballooning epithelial cells with bare nuclei, confirming the diagnosis Oral Hairy Leucoplakia (OHL). The in-situ hybridization for Epstein-Barr Virus (EBER) was positive. The patient began antiretroviral treatment, taking dolutegravir, tenofovir, and lamudivine. One month later, he presented undetectable viral load and LTCD4 of 294 cells/uL. After 2 months of follow-up, OHL showed complete clinical regression. AIDS is under control in Brazil, but clinicians must bear in mind the diagnosis of OHL in HIV+ patients. Our clinic received a 33-year-old male patient, complaining of an oral burning sensation and white lesions on the lateral border of the tongue for 7 months. He also reported weight loss and nausea, and was recently diagnosed with HIV (viral load of 1,260,000 copies/ml and LTCD4 of 86 cells/uL). Intraoral exam showed white, verrucous, and irregular plaques located bilaterally on the tongue. An incisional biopsy was performed and anatomopathological examination showed superficial squamous epithelium with ballooning epithelial cells with bare nuclei, confirming the diagnosis Oral Hairy Leucoplakia (OHL). The in-situ hybridization for Epstein-Barr Virus (EBER) was positive. The patient began antiretroviral treatment, taking dolutegravir, tenofovir, and lamudivine. One month later, he presented undetectable viral load and LTCD4 of 294 cells/uL. After 2 months of follow-up, OHL showed complete clinical regression. AIDS is under control in Brazil, but clinicians must bear in mind the diagnosis of OHL in HIV+ patients.

Limited Cutaneous Leishmaniasis as Ulcerated Verrucous Plaque on Leg, Tucson, Arizona, USA1.

We report a 34-year-old man who had a nonhealing, verrucous plaque with central ulceration on the lower leg. This case-patient is a rare example of endemic limited cutaneous leishmaniasis in Tucson, Arizona, USA. Clinicians should be aware of this disease because its manifestations can vary for individual patients.