Scott C. Howard

A man in his 20s presents w/ several-mo hx of a slowly progressive, pruritic lesion on the malleolar/ankle region. Exam shows a well-demarcated hyperkeratotic, lichenified verrucous plaque w/surface thickening & excoriations from chronic scratching. What’s the diagnosis❔

Periungual wart (verruca), most often are caused by human papillomavirus (HPV) types 1, 2, & 4. Periungual warts caused by high-risk HPV types such as HPV 16 pose a risk for malignant transformation into SCC. Dermoscopy: Papillomatous structures, each featuring a central red dot or looped vessel, surrounded by a whitish halo. These red to black tiny dots represent thrombosed, dilated capillaries and are pathognomonic of warts. Tx options: liquid nitrogen cryotherapy, electrocoagulation, CO2 or PDL, photodynamic therapy w/ methyl 5-aminolevulinic acid, oral cimetidine, intralesional bleomycin, topical cantharidin, topical diphenylcyclopropenone, topical cidofovir, topical imiquimod, & topical podophyllin alone or in combo w/ salicylic acid.

A woman in her 60s presented w/ a several-wk hx of eruptive asymptomatic blanchable vascular papules on the face, chest, back, & UEs. She denied pruritus, pain, bleeding, or systemic sx. O/E: numerous lesions composed of a central erythematous papule w/ radiating telangiectasias. No jaundice, palmar erythema, ascites, hepatomegaly, or other stigmata of CLD. PMH -ve for liver dz, EtOH misuse, pregnancy, estrogen use, endocrinopathy, CTD, or hereditary vascular syndromes. She has been taking a CCB for HTN x10 yrs. CBC, CMP, LFTs, coagulation studies, thyroid/hormonal testing, & imaging were unremarkable. What’s the diagnosis❓