Codes

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

• Common warts (verruca vulgaris) – A skin infection due to HPV. The resultant skin-colored papules are clinically indistinguishable from FCP. Common warts tend to favor the digits and extremities. However, widespread warts are observed in patients who are immunosuppressed or immunodeficient.
• Epidermodysplasia verruciformis (Lewandowsky-Lutz dysplasia) – A rare autosomal recessive disorder associated with a high susceptibility to common HPV and epidermodysplasia verruciformis-associated HPV infection. Clinically, lesions present as scaly papules and red-to-brown plaques on the face, trunk, hands, feet, and upper and lower extremities. Patients are at high risk for malignant skin tumors. Look for a positive family history and an early disease onset (before adulthood). Genetic studies reveal a mutation of the EVER1 or EVER2 gene.
• Bazex syndrome (acrokeratosis neoplastica) – A rare paraneoplastic disease associated with psoriasiform changes to the nails, followed by a gradual eruption of diffuse thickening and scaling of the fingers, palms, toes, and soles. It is associated with squamous cell carcinoma of the upper respiratory and gastrointestinal tract.
• Basal cell nevus syndrome (Gorlin syndrome / nevoid basal cell carcinoma syndrome) – A rare autosomal dominant disease associated with multiple basal cell carcinomas, often developing early in life. The lesions are pigmented papules and nodules that could resemble warts. Look for a positive family history and an early disease onset (before adulthood). Genetic studies reveal a mutation in the chromosome 9q22-31 region. Basal cell nevus syndrome is not associated with systemic malignancy.

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