Differential diagnoses: Keratinous conditions

Dr Nigel Stollery compares four keratinous conditions and offers clues for their diagnosis including actinic keratosis, ichthyosis vulgaris, seborrhoeic keratosis and hyperkeratotic horn.

Actinic keratosis

Presentation

  • UV light induced, crusted skin lesion, more common in fair-skinned individuals
  • Malignant potential although low risk of change to squamous cell carcinoma (SCC)
  • Occurs on sun-exposed areas
  • More common in men
  • Increased incidence in immunocompromised individuals
  • If diagnosis in doubt, biopsy can be helpful

Management

  • If small, emollients may be adequate
  • Various topical therapies for larger lesions
  • Cryotherapy another treatment option

Ichthyosis vulgaris

Presentation

  • Most common form of inherited ichthyosis
  • Autosomal dominant transmission
  • Affects one in 250 people
  • Symptoms usually start in childhood
  • Worse in winter and temperate climates
  • Usually less severe in older age

Management

  • Chronic condition with no cure
  • Emollients mainstay of treatment

Seborrhoeic keratosis

Presentation

  • Very common wart-like lesion of unknown aetiology
  • Greasy 'stuck on' appearance
  • Can be any colour from pale to black
  • More common with increasing age, but usually starts in patients aged over 40 years
  • Often runs in families
  • No potential for malignant change

Management

  • Treatment not usually required
  • Options include cryotherapy or curettage and cautery
  • Recurrence unlikely, but new lesions very common

Hyperkeratotic horn

Presentation

  • Can arise from different lesions, such as seborrhoeic warts, actinic keratoses or viral warts
  • 15% develop from an underlying SCC
  • Induration or inflammation at base may indicate malignancy
  • Usually asymptomatic
  • Common on sun-exposed sites

Management

  • Treatment can be undertaken with curettage and cautery
  • Base and tissue beneath should be sent for histology to exclude SCC
  • If malignancy suspected, can be referred under two-week wait rule
  • Dr Stollery is a GP in Kibworth, Leicestershire, and clinical assistant in dermatology at Leicester Royal Infirmary

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins

Register

Already registered?

Sign in

Before commenting please read our rules for commenting on articles.

If you see a comment you find offensive, you can flag it as inappropriate. In the top right-hand corner of an individual comment, you will see 'flag as inappropriate'. Clicking this prompts us to review the comment. For further information see our rules for commenting on articles.

comments powered by Disqus