Haitham M.

Saleh
Verrucous carcinoma is a rare variant of squamous cell carcinoma
occurring in the feet. It is a low-grade tumor commonly arising
from areas of chronic trauma and irritation (Najaragan et al.,
2017).
Blastomycosis-like pyoderma is a rare, cutaneous bacterial infection of
skin, seen in malnourished individuals, in a poor state of health and
manifests as vegetating skin lesions. It is an unusual tissue reaction
possibly to bacterial infection, the most common organism
being Staphylococcus aureus (Hongal et., 2016).
The papules in darier’s disease have a firm, harsh feel like coarse
sandpaper and may be skin-coloured, yellow-brown or brown in
colour. If several of the small papules grow together they may form
larger warty lesions which can become quite smelly within skin folds.
There may be a heavily crusted rash similar to seborrhoeic dermatitis
(DermNet NZ).
Hypertrophic or verrucous DLE (hypertrophic LE) is a unique subset, in which unusual
lesions occur. The thick, adherent scale is replaced by massive hyperkeratosis, and the
lesions look like warts or squamous cell carcinomas. It was also described as verrucous
lupus erythematosus or keratotic lupus erythematosus. Verrucous lesions, chronicity and
resistance to treatment are hallmarks of the disease (Narang et al., 2012).
Chromomycosis is a chronic cutaneous and subcutaneous fungal infection,
found mainly in subtropical and tropical areas (in soil and plant debris and
transmitted by traumatic inoculation), and characterized clinically by slow
growing, verrucous nodules, squamous plaques, or chronic limited lesions which
are most commonly found on the lower limbs and which are characterized
histologically by the presence of muriform cells (Orpha.net).
Crusted or Norwegian scabies is an uncommon, highly contagious, ectoparasitic infection
transmitted by Sarcoptes scabiei, mainly affecting immunosuppressed
patients. Immunocompetent individuals rarely develop crusted scabies. As a reaction to
the massive infestation, the horny layer thickens, mimicking other dermatoses such as
psoriasis, seborrheic dermatitis, Darier's disease, dermatitis herpetiformis and drug-
induced eruptions (Costa et al., 2012).
Hypertrophic lichen planus usually develops during the course of a subacute attack,
but occasionally only hypertrophic or warty lesions are found. It most often occurs
on the lower limbs, especially around the ankles. Hypertrophic lesions persist for
many years. When such lesions eventullay clear, an area of pigmentation and
scarring may remain and there is often some degree of atrophy (Namazi et al.,
2008).
Verrucous psoriasis (VP) is a rare variant of psoriasis characterized by
hyperkeratotic, papillomatous plaques that clinically resemble verrucous carcinoma
(VC) in lesion appearance and distribution. It is amenable to medical treatments
(Gravie et al., 2019).
Occurs after direct inoculation of TB into the skin in someone who has been
previously infected with mycobacteria, presents as a purplish or brownish-
red warty growth, lesions most often occur on the knees, elbows, hands, feet and
buttocks and may persist for years but can clear up even without treatment (Derm
NetNZ).
The skin is the most common site of dissemination of
coccidioidomycosis. Involvement ranges from superficial
maculopapules, keratotic nodules, and verrucous ulcers to subcutaneous
fluctuant abscesses (emedicine).
The verrucous plaque with ulceration and black crust, extending to the
left side of the nose tip, ala nasi, and anterior nasal septum sparing
nasal mucosa. Note two erythematous papulo-plaque lesions over the
left cheek in a lymphocutaneous pattern (verma et al., 2019).
Thank You