Clinical clues for differential diagnosis between verruca plana and verruca plana‐like seborrheic keratosis

Sometimes the clinical differentiation between verruca plana (VP) and VP‐like seborrheic keratosis (SK) could be challenged. However, there have been no studies on this issue to date. The aim of this study was to elucidate clinical and dermoscopic differences between these two diseases, and also to suggest a diagnostic algorithm of VP and VP‐like SK without skin biopsy. The patients who had lesions clinically considered as VP or VP‐like SK were the target of our study. We took clinical and dermoscopic photos with informed consent and conducted a questionnaire. All patients had their diagnoses confirmed by biopsy. Thirty‐three patients were enrolled in our study. Seventeen patients were finally diagnosed with VP (51.5%) and 16 patients with VP‐like SK (48.5%). In clinical findings, VP‐like SK showed significantly more scattered distribution than VP (P = 0.039), which exhibited more clustered or grouped distribution (P = 0.039). In dermoscopic findings, brain‐like appearance was more commonly observed in VP‐like SK (P = 0.003) whereas VP showed more red dots or globular vessels (P = 0.017) and even‐colored light brown to yellow patch (P < 0.001). Sex, onset age, the size of each lesion, location, color and shape showed no significant differences between them (P > 0.05). Based on our results, we suggest a diagnostic algorithm using Koebner's phenomenon, dermoscopic findings, distribution of each lesion and biopsy for multiple VP‐like lesions in adults, and we think it will be a very useful diagnostic tool in daily clinical dermatological practice.     

Various tumors in the nasal vestibule

Various types of diseases can involve the nasal vestibule. Diagnosis and treatment of a nasal vestibular mass is often challenging due to the anatomical features of the nasal vestibule. Here, we present four cases with nasal vestibular masses. Two cases were diagnosed as squamous papillomas. The others were a trichofolliculoma and pseudoepitheliomatous hyperplasia with hyperkeratosis. Our aim was to discuss the characteristics of each disease and the considerations thought to be necessary for diagnosis and treatment of nasal vestibular tumors from these cases and the related literature.     

Wart with Depigmented Halo and Generalized Vitiligo

Depigmented haloes sometimes appear around melanocytic tumors or non-melanocytic tumors, but coexistence of warts and depigmented haloes is extremely rare. We report here an unusual case of warts accompanied by depigmented haloes and subsequently-triggered generalized vitiligo. A 55-year-old Japanese man presented with a 3-year history of brown nodules on the back, upper eyelid and dorsum of the left hand. Depigmented haloes appeared around the noldules and then gradually spread over a wide area, resulting in the development of generalized vitiligo. He had no history of antecedent treatment for these lesions before consultation. Histopathologically, the lesion showed papillomatosis and hyperkeratosis with lymphocytic exocytosis into the epidermis, which compatible to warts. Based on these clinical and histopathologic findings, a diagnosis of warts with depigmented halo and subsequently-triggered generalized vitiligo was made. None of the warts had resolved spontaneously after the appearance of haloes, and the depigmented haloes and generalized vitiligo remain unchanged.     

Treatment of verruca vulgaris with topical cidofovir in an immunocompromised patient: a case report and review of the literature

Lesions caused by verrucus vulgaris are commonly refractory to therapy and may become large, painful, or disfiguring in immunocompromised patients. Cidofovir is a potent nucleoside analog antiviral agent shown to have in vitro and in vivo activity against a broad spectrum of DNA viruses. We report a successful use of topical cidofovir to treat verruca vulgaris lesions in a highly immunocompromised patient, who was not considered a candidate for conventional therapy.     

自拟消疣煎治疗扁平疣临床疗效观察

目的寻求扁平疣最佳治疗方法。方法将本科门诊139例扁平疣患者随机分为两组，观察组71例采用中药内服、外洗＋口服胸腺肽口服肠溶片、每晚外用维A酸乳膏中西医结合的方法治疗至疗程结束；对照组68例单用口服胸腺肽肠溶片、每晚外用维A酸乳膏治疗至疗程结束。两组治疗前后分别详细观察并记录皮疹部位、数量变化及不良反应。结果观察组愈显率88．73％；对照组愈显率61．76％。中西医结合组疗效明显优于单纯西药组，且观察组不良反应少于对照组。结论中药内服外洗配合胸腺肽治疗扁平疣疗效满意，安全副作用少。     

The Effect of Cimetidine on Verruca Plana Juvenilis: Clinical Trials in Six Patients

Cimetidine is an H₂-receptor antagonist which is mainly used to treat gastrointestinal diseases. Recently, many authors have suggested that cimetidine has the ability to reverse acquired tolerance to dinitrochlorobenzene (DNCB). We have used cimetidine in six patients with verruca plana who showed no therapeutic response to DNCB. Four of them responded and showed complete disappearance of the verruca plana. The mean duration of oral cimetidine administration (1.2 g/day) was 4 weeks until the disappearance. Therefore, we suggest that oral cimetidine can be used as an effective and safe adjunctive modality for the treatment of verruca plana.     

Detection of human papillomavirus-related oral verruca vulgaris among Venezuelans

A sensitive in situ hybridization test under low stringency conditions (LCS) with a set of digoxigenin-labeled human papillomavirus mixed probes (D-L HPV MP) revelaed a positive reaction in 8 of 10 cases of oral verruca vulgaris (OVV), Ages ranged from 5 to 37 years with a mean of 14.5 years. 50% of all cases were located intraorally on the hard palate, followed in frequency by the commissures. These preliminary findings provide evidence of the role of HPV in OVV from a sample of the Venezuelan population. We show that in situ hybridization conducted under LSC is useful in HPV detection (regardless of the type) and the digoxigenin-labeling system is a rapid, relatively easy and specific method. In addition, this technique permits the retrospective evaluation of routinely processed material, thus widening the investigative spectrum for HPV.