Differentiating cutaneous dells
A 26-year-old African American man presented with keratotic dells that had appeared on his heels and soles within the past six years. The papules did not itch, burn, or hurt. A few similar lesions were visible on his hands; he thought a family member also had similar lesions. The patient had been told by another clinician that the lesions were warts. Biopsy showed a hyperkeratotic epidermis without columns of parakeratosis or elastorrhexis. There was no histologic evidence of warts, e.g., digitated epidermal hyperplasia, acanthosis, papillomatosis, dilated tortuous capillaries within the dermal papillae, compact orthokeratosis, or hypergranulosis. The patient had no other medical problems or malignancy.
A 44-year-old man presented with slightly painful lesions—one on his right heel and the other on his dorsal right toe. He had no other medical problems and did not take any medications. He had previously had verrucous papules on his hands, but these had abated with cryotherapy and topical imiquimod (Aldara) for 20 weeks. The pedal lesions were slightly painful. There were no verrucous lesions on his right foot. The lesions were frozen, pared, and desiccated. When application of imiquimod and tazarotene gel 0.1% (Tazorac) had no effect at 20 weeks, the patient took a break from treatment. By that time, the lesions, though still present, were no longer painful.