Dermatologic Look-Alikes…

175 Pages·2009·1.6 MB·English

Dermatologic Look-Alikes,
Module III
Lou Mancano MD, FAAFP
The Reading Hospital &
Medical Center
PAFP South Central Assembly
September 19, 2009
Objectives
Recognize characteristics that aid in

diagnosing similar-appearing skin lesions and
conditions
Use visual and other diagnostic modalities to

assist in differentiating skin conditions that may
look alike
Formulate treatment options for the presented

look-alike skin conditions
Disclosure Information
Louis D. Mancano, M.D.
I have no relevant financial relationships to

disclose.
AND –
-
I will discuss the following off-label and/or

investigational use in my presentation.
UVB light therapy, topical immunomodulators, topical

tretinoin, topical calcipotriol, and oral
hydroxychloroquine are mentioned as off-label
treatments for some conditions presented
Practice Recommendation
Screening for Skin Cancer
The USPSTF concludes that the current

evidence is insufficient to assess the balance
of benefits and harms of using a whole-body
skin examination by a primary care clinician or
patient skin self-examination for the early
detection of cutaneous melanoma, basal cell
cancer, or squamous cell skin cancer in the
adult general population.
This is an I statement.

http://www.ahrq.gov/clinic/uspstf09/skincancer/skincanrs.pdf
Flat Warts Angiofibromas
Steroid Acne Keratosis Pilaris
Flat Warts
Flat Warts (Verruca Plana)
Benign proliferations of keratinized epithelium

Caused by infection with types 3, 10, and 28 of

the human papillomavirus (HPV)
Autoinoculation also may occur

Incubation period ranges 1 - 6 months

Flat Warts (Verruca Plana)
Slightly elevated flesh-

colored to
hyperpigmented papules
Smooth or slightly

hyperkeratotic
Size usually 1 - 5 mm

Numbers range from a

few to hundreds that
may become grouped or
confluent
Flat Warts (Verruca Plana)
May occur anywhere on the skin and mucous

membranes. Most common areas:
face (children)
–
hands
–
beard area and shins (adults)
–
Koebner phenomenon - irritation from shaving legs and

beard area probably accounts for this
Flat Warts
Treatment

Destructive methods - desiccation, freezing, and
–
lasers are 60 to 80% effective
Imiquimod - immune modifier approved for
–
treatment of genital warts, but reports indicate
successful tx of other warts.
Topical tretinoin (retinoic acid) has some success
–