Verrucous Skin Lesions Research Articles

Triple therapy approach for treating chromoblastomycosis in a Lebanese patient.

Chromoblastomycosis, though rare in non-endemic regions like Lebanon, should be considered in patients presenting with chronic, verrucous skin lesions unresponsive to conventional therapies. Multimodal treatment combining oral antifungals, cryotherapy, and adjunctive topical 5-Fluorouracil demonstrates efficacy in managing refractory cases. Follow-up visits three and 6 months after treatment cessation showed sustained lesion clearance and no recurrence.

A Case of Verrucous Skin Lesions on the Feet in Diabetic Neuropathy on the Left First Toe

A Case of Verrucous Skin Lesions on the Feet in Diabetic Neuropathy on the Left First Toe

Unusual Presentation of Chromoblastomycosis with a Brief Review of its Atypical Cutaneous Presentations.

Sir, Chromoblastomycosis (CM) is a chronic subcutaneous fungal infection clinically characterized by verrucous skin lesions. The disease frequently involves the lower extremities of adult males who work barefoot in agricultural fields.[1] A history of themechanical trauma or injury to the site ofinfection marks the portal of entry as the fungal spores may be present in the soil and plant debris. Chromoblastomycosis lesions are polymorphic. The diagnosis is confirmed bythe histopathological demonstration of chromo bodies/muriform cells inthe tissue and isolation and identification of the species in culture. There are different species of dematiaceous fungi causing CM of which Fonsecaea pedrosoi is the most common.[2] Here, we report an atypical presentation of CM in a female from a hilly area. A 48-year-old female rubber tapper from a hilly area presented with asymptomatic reddish raised lesions overthe volar aspect of theright forearm of 3 years duration. Thelesions started as a single small red raised lesion and progressively increased in size and number over a period. She also developed a few pus-filled lesions in between. The lesions were asymptomatic. She denied any history of trauma. On examination, there were predominantly erythematous-infiltrated papules, both discrete and confluent, with the skin in between in some areas showing hypopigmentation, along with a few pustules localized to a single site on the volar aspect of theright forearm [Figure 1]. With the clinical possibility of sarcoidosis and papular-type of lupus vulgaris, the patient was investigated. The chest X-ray was normal and theMantoux test wasnegative. The Retro test was negative. The investigations for sarcoidosis were non-contributory. The skin biopsy demonstrated chromobodies (muriform bodies) inside thegiant cells, the hallmark of chromoblastomycosis [Figure 2]. The fungal culture on Sabourauds dextrose agar showed slightly heaped black velvety and hairy colonies, suggestive of dematiaceous fungi. On slide culture microscopy and normal saline mount, theconidiophores were brown and showed dense apical branching with elongated macroconidia and clustered round-to-oval microconidia [Figure 3], while a high power showed the macroconidia to be barrel-shaped and microconidia shield-shaped, characteristic features of genus Fonsecaea [Figure 4]. She was started on oral itraconazole 200 mg daily. She is now under follow-up in the outpatient clinic.Figure 1: Multiple discrete erythematous-infiltrated papules and pustules on the volar aspect of the right forearmFigure 2: Skin biopsy showing multiple yellowish-brown sclerotic chromobodies in the giant cells, H and E X400Figure 3: Slide culture microscopy showing brown conidiophores with apical branching (vertical arrow) with elongated macroconidia (right pointing black arrow) and clustered round-to-oval microconidia (left pointing black arrow), normal saline mount X100.Figure 4: High power showing the macroconidia to be barrel-shaped and microconidia shield-shaped, characteristic features of genus Fonsecaea, normal saline mount X400CMis one of the most frequent infections caused by melanized fungi. Nodular, plaque-type, tumoral, ulcerative, cicatricial, sporotrichoid, and verrucous are the common clinical types described.[3] Our patient presented with erythematous-infiltrated papules and a few pustules on the forearm, without any preceding trauma and clinically not suggestive of CM. Relevant investigations did not support the diagnosis of sarcoidosis or lupus vulgaris. However, histopathology showed chromobodies in the giant cells and the fungal culture demonstrated dematiaceous fungi and theslide culture microscopy showed characteristic features of the genus Fonsecaea. Therefore, we made a final diagnosis of CM with atypical presentation mimicking sarcoidosis/papular lupus vulgaris caused by Fonsecaea. Presentation with multiple discrete and confluent papules mimicking sarcoidosis is very rare for CM. Since this is a pigmented dematiaceous fungi, it can be demonstrated in routine H and E stains and normal saline and KOH-mounted slides and does not require special stains. Sarcoidosis-like presentation is very rare for CM. Hence, a very careful histopathological examination is of paramount importance, otherwise, the diagnosis may be missed since sarcoidosis is not a rare disease in India with an estimate between 61 and 150 cases per 100,000 in outdoor patients according to a study done in India, and wrong treatment could be given to the patient.[4] The drug of choice for CM is itraconazole 200–400 mg per day till clinical remission. Terbinafine, Fluconazole, and potassium iodide are also effective.[58910] CM can present with rare atypical presentations and the various rare clinical presentations are given in Table 1. We are reporting a very rare presentation of CM.Table 1: Rare presentations of chromoblastomycosisFinancial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Detection of Human Papillomaviruses (HPVs) by Immunohistochemistry (P16ink4a) In Verrucous Skin Lesions

Even though the p16 marker allows us to distinguish between benign and malignant verrucous skin lesions, we are unable to determine the patient's Human Papillomaviruses (HPVs) status despite the existence of recognized histopathological features that indicate its presence like koilocytic change, since a proper correlation couldn’t be made between this feature and p16 expression. Even though PV type 16 and 18 are a risk factor for developments of anogenital skin lesion diffuse p16 expression cannot always be attributed to HPVs as there may be several other risk factors causing skin lesions, unlike in cervical lesions such as squamous cell carcinomas, many studies have established the role of oncogenic HPVs with its carcinogenesis. This marker cannot be used as a surrogate for detection of HPV infection. The present study was the expression of p16INK4A in histological sections of verrucous skin lesions. To compare the expression of p16INK4a in benign, premalignant and malignant lesions involving the skin and comparing the pattern of expression of p16INK4a in skin lesions by immunohistochemistry and correlating the results with certain histological parameters that might indicate HPV infection.

Blastomycosis presenting as an isolated progressive painless verrucous skin lesion.

A painless progressive verrucous skin plaque in an endemic area should raise suspicion for blastomycosis resulting in prompt biopsy with fungal stains and culture. Skin is a common extrapulmonary site. Itraconazole is treatment of choice.

糖尿病神経障害を有する患者に発症した verrucous skin lesions on the feet in diabetic neuropathy の 1 例

糖尿病神経障害を有する患者に発症した verrucous skin lesions on the feet in diabetic neuropathy の 1 例

Adiaspiromycosis Presenting with Left Wrist Tenosynovitis and Hyperpigmented Verrucous Skin Lesions

Adiaspiromycosis Presenting with Left Wrist Tenosynovitis and Hyperpigmented Verrucous Skin Lesions

Verrucous skin lesions on the feet in diabetic neuropathy: Successful treatment using a hollowed‐out sponge

Australasian Journal of DermatologyVolume 55, Issue 2 p. 158-159 LETTER TO THE EDITOR Verrucous skin lesions on the feet in diabetic neuropathy: Successful treatment using a hollowed-out sponge Kohei Yamauchi, Kohei Yamauchi Department of Dermatology, National Defence Medical College, Saitama, JapanSearch for more papers by this authorTakashi Kobayashi, Takashi Kobayashi Department of Dermatology, National Defence Medical College, Saitama, JapanSearch for more papers by this authorChika Kawakubo, Chika Kawakubo Department of Dermatology, National Defence Medical College, Saitama, JapanSearch for more papers by this authorNorihiro Fujimoto, Norihiro Fujimoto Department of Dermatology, National Defence Medical College, Saitama, JapanSearch for more papers by this authorTakahiro Satoh, Takahiro Satoh Department of Dermatology, National Defence Medical College, Saitama, JapanSearch for more papers by this authorShingo Tajima, Shingo Tajima Department of Dermatology, National Defence Medical College, Saitama, JapanSearch for more papers by this author Kohei Yamauchi, Kohei Yamauchi Department of Dermatology, National Defence Medical College, Saitama, JapanSearch for more papers by this authorTakashi Kobayashi, Takashi Kobayashi Department of Dermatology, National Defence Medical College, Saitama, JapanSearch for more papers by this authorChika Kawakubo, Chika Kawakubo Department of Dermatology, National Defence Medical College, Saitama, JapanSearch for more papers by this authorNorihiro Fujimoto, Norihiro Fujimoto Department of Dermatology, National Defence Medical College, Saitama, JapanSearch for more papers by this authorTakahiro Satoh, Takahiro Satoh Department of Dermatology, National Defence Medical College, Saitama, JapanSearch for more papers by this authorShingo Tajima, Shingo Tajima Department of Dermatology, National Defence Medical College, Saitama, JapanSearch for more papers by this author First published: 11 April 2014 https://doi.org/10.1111/ajd.12171Citations: 3 Conflict of interest: none. Kohei Yamauchi, MD. Takashi Kobayashi, PhD. Chika Kawakubo, MD. Norihiro Fujimoto, PhD. Takahiro Satoh, PhD. Shingo Tajima, PhD. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume55, Issue2May 2014Pages 158-159 RelatedInformation

Low p53 positivity in verrucous skin lesion in diabetic neuropathy occurring on the dorsum of the foot

Low p53 positivity in verrucous skin lesion in diabetic neuropathy occurring on the dorsum of the foot

Verrucous skin lesions on the feet in diabetic neuropathy successfully treated with topical maxacalcitol

ejd.2012.1640 Auteur(s) : Kazutoshi Murao kmurao@clin.med.tokushima-u.ac.jp, Mika Oshima, Osamu Miyajima, Yoshiaki Kubo Department of Dermatology, Institute of Health Biosciences, University of Tokushima Graduate School, 3-15-18 Kuramoto-cho, Tokushima 770-8503, Japan Verrucous skin lesions on the feet in diabetic neuropathy (VSLDN) was first described by Gerbig and Hunziker in 1995 [1]. Chronic pressure or friction in an area of sensory loss is considered an important factor for development of [...]

Verrucous skin lesions on the feet in diabetic neuropathy successfully treated with topical maxacalcitol

ejd.2011.1637 Auteur(s) : Monji Koga1, Kaori Koga2, Kenji Isitsuka3, Shinichi Imafuku1, Juichiro Nakayama1 mob3mob3@yahoo.co.jp 1 Department of Dermatology, 2 Department of Pathology, 3 Division of Medical Oncology, Fukuoka University School of Medicine, 7-45-1 Nanakuma Jonan-ku, Fukuoka, 814-0180, Japan A 68-year-old Japanese man suffered from mild generalized plaque-type psoriasis for 20 years. He had had long term treatment with topical corticosteroids and olopatadine hydrochloride. After cyclosporine [...]

Homozygosity for the c.917A → T (p.N306l) Polymorphism in the EVER2/TMC8 Gene of Two Sisters with Epidermodysplasia Verruciformis Lewandowsky-Lutz Originally Described by Wilhelm Lutz

Background: Epidermodysplasia verruciformis Lewandowsky-Lutz (EV) is a rare genodermatosis, characterised by development of numerous verrucous skin lesions caused by specific genotypes of human papillomaviruses belonging to the β-papillomavirus genus. The EV loci were mapped to chromosome 2p21–p24 (EV2) and 17q25 (EV1). On chromosome 17, 2 adjacent related genes – EVER1/TMC6 and EVER2/TMC8 – were identified. We reinvestigated 2 patients originally described by Wilhelm Lutz in 1946 with the aim to document the natural course of the disease and confirm his diagnosis. Methods: PCR fragments specific for exons with short flanking intron sequences of EVER1/TMC6 and EVER2/TMC8 genes from patients’ DNA were amplified using sequence information. The single-nucleotide polymorphism (SNP) rs7208422 was studied, using restriction fragment length polymorphism analysis. Results: In the index patient, we identified a homozygous TT genotype in exon 8 of the EVER2/TMC8 gene (c.917A → T, p.N306I). The same mutation could thereafter be detected in her sister from paraffin-embedded skin. Conclusion: We have followed one of the first patients described with EV in Basel, Switzerland, in 1930 until today and demonstrated the TT genotype (SNP rs7208422) in the EVER2/TMC8 gene in this index patient and her sister. The results underline the possible relevance of SNP rs7208422 by influencing the susceptibility to β-papillomaviruses and their oncogenic potential.

Verrucous Skin Lesions on the Feet in Diabetic Neuropathyの1例

Verrucous Skin Lesions on the Feet in Diabetic Neuropathyの1例

Detection of high-risk human papillomaviruses in verrucae of patients with mycosis fungoides and Sézary syndrome: a case series

Mycosis fungoides (MF)/Sézary syndrome (SS) patients are immunocompromised and thus may be susceptible to high-risk human papillomavirus (HPV) infections that are difficult to treat. Three patients with verrucous skin lesions, 2 of whom had coexisting squamous cell carcinoma (SCC) near the verruca biopsy site, had biopsies of verruca for histologic examination. HPV typing was performed on fresh verruca biopsies by nested polymerase chain reaction. A single type of high-risk HPV was identified in each patient's lesion. HPV may have acted as a cocarcinogen in the development of SCC in two patients and extensive condyloma acuminatum in one.

Verrucous skin lesions on the feet in diabetic neuropathyに類似した象皮様皮膚角化を呈し，Prevotella melaninogenica感染を合併した糖尿病足壊疽の1例

Verrucous skin lesions on the feet in diabetic neuropathyに類似した象皮様皮膚角化を呈し，Prevotella melaninogenica感染を合併した糖尿病足壊疽の1例

Verrucous Carcinoma Originating from a Diabetic Foot Ulcer: A Case Report

Background: It has been well-documented that chronic pressure or friction in the area of sensory loss might cause verrucous skin lesions especially on the feet of diabetic neuropathy victims. However, malignant change of these skin lesions have not yet been frequently reported. We report here a rare case of verrucous carcinoma originating from a diabetic ulcer and review the literature. Case Presentation: A 49-year-old male is a victim of diabetes mellitus. Due to osteomyelitis, he had received left third toe amputation, left second metatarsal sequestrectomy, and fourth toe shortening at distal phalangeal shaft two years before admission. He noted a fungating ulceration on his left dorsal foot which was at the base of the second toe 8 months before his coming for help. Initial skin biopsy was done and preliminary pathology results revealed verruca vulgaris. However, the fungating mass enlarged even after several scalpel shavings with topical antibiotics ointment. A second skin biopsy was done 3 months later. Unfortunately, histology results showed verrucous carcinoma. Sectional margin-free wide excision was done and full thickness skin graft was used to cover the soft tissue defect. Conclusion: In treating chronic diabetic ulcers, the possibility of potentially malignant change of the wound must be taken into consideration once the lesions persist or aggravate without infection or other offending factors. Any violating infection should be controlled by aggressive antimicrobial therapy with surgical debridement. Further biopsy should be performed to clarify any suspected malignant changes.

Human papilloma virus prevalence in laryngeal squamous cell carcinoma

To determine the prevalence and type of human papilloma virus deoxyribonucleic acid (DNA) in cases of laryngeal squamous cell carcinoma. We analysed the prevalence of human papilloma virus infection in archived paraffin block specimens taken from 99 cases of laryngeal squamous cell carcinoma between 1990 and 2005, using polymerase chain reaction techniques. Biopsy specimens from five proven verrucous skin lesions were used as positive controls, and peripheral blood samples from five healthy volunteers were used as negative controls. Four test samples were found to have inadequate deoxyribonucleic acid purity and were therefore excluded from the study. Human papilloma virus deoxyribonucleic acid was detected in seven of 95 cases of laryngeal squamous cell carcinoma (7.36 per cent). Human papilloma virus genotyping revealed double human papilloma virus infection in three cases and single human papilloma virus infection in the remaining four cases. The human papilloma virus genotypes detected were 6, 11 and 16 (the latter detected in only one case). In our series, a very low human papilloma virus prevalence was found among laryngeal squamous cell carcinoma cases. The human papilloma virus genotypes detected were mostly 6 and/or 11, and 16 in only one case. To the best of our knowledge, this is the first report of human papilloma virus prevalence in laryngeal squamous cell carcinoma, based on polymerase chain reaction genotyping in a Turkish population.

Epidermodysplasia verruciformis and generalized verrucosis: the same disease?

We report a patient with epidermodysplasia verruciformis (EV) who had severe generalized verrucous skin lesions for 50 years without any immunological abnormality. Microscopic examination showed two histopathological features, including seborrhoeic keratosis and common warts. The detected human papilloma virus (HPV) types were found to be HPV 3, 50, 5, and 76, using a degenerate PCR method. EV and generalized verrucosis are distinguished by slight differences in clinical symptoms or HPV types, so there should be no apparent differential points common to both diseases. Therefore, we propose that an abnormal susceptibility specific to HPV, which is the most characteristic feature in EV, should be regarded as a differential point in these two diseases.

Alterations of epidermal proliferation and cytokeratin expression in skin biopsies from heavy draught horses with chronic pastern dermatitis

We report the historical, clinical and histopathological characteristics of skin lesions in biopsies from 37 heavy draught horses with chronic pastern dermatitis. The skin lesions were divided into four macroscopic groups: scaling (group I, n=5), hyperkeratotic and hyperplastic plaque-like lesions (group II, n=14), nodular skin masses (group III, n=16) and verrucous skin lesions (group IV, n=2). The principal histological findings were hyperkeratosis and epidermal hyperplasia. There was a gradual increase in epidermal hyperplasia from groups I to IV, suggesting that the lesions represent different stages of disease. In all cases, there was perivascular dermatitis dominated by T lymphocytes with an increase in MHC class II-positive dendritic-like cells. Immunohistochemical labelling for cytokeratins CK5/6(4), CK10 and CK14 indicated a change in their expression pattern. This correlated with the degree of epidermal hyperplasia, indicating abnormal differentiation of keratinocytes. There was a statistically significant correlation between the severity of skin lesions and several other factors including increasing age, increasing cannon circumference, prominence of anatomical structures such as fetlock tufts of hairs, ergots and chestnuts, and bulges in the fetlock region.

Verrucous skin lesions on the feet in diabetic neuropathy

Verrucous skin lesions on the feet in diabetic neuropathy