Clinical clues for differential diagnosis between verruca plana and verruca plana‐like seborrheic keratosis

Abstract

Sometimes the clinical differentiation between verruca plana (VP) and VP-like seborrheic keratosis (SK) could be challenged. However, there have been no studies on this issue to date. The aim of this study was to elucidate clinical and dermoscopic differences between these two diseases, and also to suggest a diagnostic algorithm of VP and VP-like SK without skin biopsy. The patients who had lesions clinically considered as VP or VP-like SK were the target of our study. We took clinical and dermoscopic photos with informed consent and conducted a questionnaire. All patients had their diagnoses confirmed by biopsy. Thirty-three patients were enrolled in our study. Seventeen patients were finally diagnosed with VP (51.5%) and 16 patients with VP-like SK (48.5%). In clinical findings, VP-like SK showed significantly more scattered distribution than VP (P = 0.039), which exhibited more clustered or grouped distribution (P = 0.039). In dermoscopic findings, brain-like appearance was more commonly observed in VP-like SK (P = 0.003) whereas VP showed more red dots or globular vessels (P = 0.017) and even-colored light brown to yellow patch (P < 0.001). Sex, onset age, the size of each lesion, location, color and shape showed no significant differences between them (P > 0.05). Based on our results, we suggest a diagnostic algorithm using Koebner's phenomenon, dermoscopic findings, distribution of each lesion and biopsy for multiple VP-like lesions in adults, and we think it will be a very useful diagnostic tool in daily clinical dermatological practice.

Dermoscopy of pigmented papillated Bowen disease: A report of two cases

“…2,3 On the other hand, pigmented papillated Bowen disease shows no characteristic structures, such as milia-like cysts, comedo-like openings and a brainlike appearance, which are major components of seborrheic keratosis seen with dermoscopy, as in our two cases. 4,5 In conclusion, we describe the dermoscopic features of pigmented papillated Bowen disease and suggest that irregular fissures/ridges and structureless brown areas may be critical dermoscopic features of pigmented papillated Bowen disease to differentiate it from seborrheic keratosis.…”

Verruca plana mimicking seborrheic keratosis in the elderly: A case report

“…Differentiating between verruca plana and verruca plana-like seborrheic keratosis is difficult. Only one study has differentiated between these conditions based on the clinical and dermoscopic findings [8]. Verruca plana showed clustered or grouped distribution, Koebner’s phenomenon, and dermoscopic features of more red dots or globular vessels than seborrheic keratosis [8].…”

“…Only one study has differentiated between these conditions based on the clinical and dermoscopic findings [8]. Verruca plana showed clustered or grouped distribution, Koebner’s phenomenon, and dermoscopic features of more red dots or globular vessels than seborrheic keratosis [8]. Due to the discrepancy in treatment, tissue biopsy for dermatopathology is still the gold standard for a definite diagnosis.…”

Flat‐topped papules arising in a young woman's tattoo

“…Previous studies show that patients may be inoculated with HPV during tattoo procedures . There are only a few reports of SK arising in tattoos, and the clinical distinction between this entity and HPV lesions is still challenging to dermatologists . According to one previous study, confocal laser scanning microscopy may be a useful tool to help the definitive diagnosis but is still unavailable in most of the clinics .…”