More skin problems - what links them?

[Soroush Ebrahimi]

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What links these dermatological problems?
25 May 11
Each of the dermatological presentations pictured has something in common. What is it? Answers at
the bottom of the page
This quiz was compiled by consultant dermatologist Dr Amanda Oakley and first appeared in our sister
publication NZ Doctor


44
Answers
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They are all viral warts, or are wart-related. Warts are benign neoplasms of the skin and mucosae,
caused by HPV infection.
1 Mosaic warts
Mosaic warts form large plaques, are relatively asymptomatic and are usually found on plantar
surfaces.
2 Flat (or plane) warts
These are associated with HPV types 3 and 10. They are smooth or dry, small papules or plaques,
often numerous on face, hands and shins. They frequently koebnerise - for example, after shaving or
scratching - resulting in linear array.
3 Intraoral warts
A mucosal wart is a hyperkeratotic soft skin-coloured condyloma tapering to a sharp point, hence
'acuminata', often forming large plaques. Intraoral warts are usually misplaced genital HPV types,
but those on the lips may also be common or filiform variants.
4 Vulval intraepithelial neoplasia
It is well established that HPV 16 and 18 may lead to cervical, penile and vulval intraepithelial
neoplasia and invasive cancers.
5 Epidermodysplasia verruciformis
This is a very rare genetic disorder in which widespread cutaneous warts of multiple HPV types are
prone to oncogenic transformation (especially lesions infected with HPV 5). Patients present with
disseminated flat warts, pityriasis versicolor-like lesions (as seen in the picture) and squamous
cell carcinoma.
6 Warts as a result of induced immunosuppression
Profound drug-induced immunosuppression associated with organ transplantation can result in
extensive warts on non-genital sites.