Painless growths felt like stones in her shoes by ProQuest


Examination findings of the patient's remaining skin were unremarkable. WHAT IS YOUR DIAGNOSIS? * Verruca plantaris * Piezogenic pedal papules * Squamous cell carcinoma * Corns DISCUSSION The patient has verruca plantaris, a condition commonly known as plantar warts. In nonimmunosuppressed patients, cure rates can be as high as 80%.1 In many renal transplant recipients, the goal is to keep warts under control because chronic immunosuppression makes a cure unrealistic.

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									derm1208.qxp      11/21/08         3:23 PM       Page 16

                                               Dermatology Digest
                                                                 C H E RY L L . G R E E N , PA- C

                                                           ›CASE                                        the heels, are smooth, and disappear
                                                           A 24-year-old white female presented         when the person takes weight off their
                                                           to the dermatology clinic with a 2-year      feet. Our patient’s growths were on the
                                                           history of growths on the soles of her       outside of the skin.
                                                           feet. The growths were not painful              Although an unlikely diagnosis, squa-
                                                           when walking, but felt like “a bunch of      mous cell carcinoma (SCC) should be
                                                           stones in her shoes.” The patient tried      included in the differential because it
                                                           several OTC callous-removal products,        can be caused by HPV and our patient
                                                           but they were ineffective. The growths       has multiple risk factors because of a
                                                           appeared to be more prominent in the         renal transplantation. However, SCC is
                                                           weight-bearing areas of her feet.            most commonly found on the head,
                                                             The patient had undergone a kidney         neck, and upper extremities.
                                                           transplant 3 years previously. Her              Corns usually occur on the toes sec-
                                                           medications included azathioprine            ondary to persistent friction or pres-
                                                           (Imuran), 150 mg daily; prednisone,          sure. Corns can be painful when per-
                                                           10 mg every other day; amiloride/            forming weight-bearing activities like
                                                           hydrochlorothiazide (Moduretic), 5 mg/       walking or standing. However, skin
                                                           50 mg daily; pantoprazole (Protonix),        lines are preserved. Corns have a clear
           FIGURE 1                                        40 mg daily; and risedronate (Actonel),      center and lack thrombosed capillaries
           Hyperkeratotic papules                          35 mg weekly. She was otherwise              when pared down with a scalpel.
           and plaques on the foot                         healthy. She denied using tobacco, alco-        Treatment Plantar warts can occur as
                                                           hol, or illicit drugs.                       a single, discrete lesion or may coalesce
                                                             Physical examination revealed multi-       and appear in a plaquelike configura-

      Painless                                             ple hyperkeratotic papules and plaques
                                                           on the soles of the feet (see Figure 1).
                                                           No associated erythema or edema was
                                                                                                        tion on the plantar surface of the feet.
                                                                                                        When plantar warts are pared down,
                                                                                                        an interruption of skin lines and the

      growths felt                                         found. Some scal
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