A case series of verrucae vulgares mimicking hyperkeratosis in individuals with diabetic foot ulcers. Issue 8 (August 2017)

• Record Type: Journal Article
• Authors: Quast, D. R.; Nauck, M. A.; Bechara, F. G.; Meier, J. J.
• Is Part Of: Diabetic medicine. Volume 34:Issue 8(2017)
• Page Start: 1165
• Page End: 1168
• Publication Date: 2017-08
• Subjects: Diabetes -- Periodicals; 616.462
• DOI: 10.1111/dme.13387
• Languages: English
• ISSNs: 0742-3071

Abstract

Abstract: Background: Diabetic foot ulcers are a common complication in the advanced stages of diabetes mellitus. Certain lesions may be refractory to usual treatments with prolonged healing. In these cases, differential diagnoses to classical ulcers should be considered. Although plantar warts are a common and easy‐to‐diagnose finding in the general population, diagnosis can be challenging in people with diabetic foot ulcers, as they mimic hyperkeratosis in these people. Case report: We report seven cases of people with diabetic foot ulcers and verrucae vulgares mimicking treatment‐refractory hyperkeratosis, presenting to our centre between 2014 and 2016. Diagnosis was aided by the clinical presentation, followed by dermoscopy and punch biopsy. Treatment included topical application of 5‐fluoruracil and salicylic acid (four people), cryotherapy (three people) and surgical excision (three people), all in combination with local pressure offloading. In five people, the verrucae were completely removed after a mean treatment period of 9.4 months; two individuals were lost to follow‐up. Conclusion: Verrucae may be more common in people with diabetic foot lesions and polyneuropathy than generally assumed. Typical findings include small, pinhead‐sized bleedings within and surrounding hyperkeratous lesions. These findings should alert the clinician for the potential presence of a verruca. In such cases, biopsy should be performed to enable specific diagnosis and treatment. What's new?: The clinical presentation of plantar warts and diabetic hyperkeratosis might be similar. Typical clinical hallmarks may help to diagnose verrucae. The treatment of plantar warts differs markedly from that of typical diabetic foot lesions.