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

Follow Us:

Just published

Redacting information from medical records - advice for GPs

Redacting information from medical records - advice for GPs

MDU medico-legal adviser Dr Ellie Mein provides advice for GPs on reacting information...

Medicine shortages set to continue despite Brexit delay

Medicine shortages set to continue despite Brexit delay

Medicine shortages are unlikely to improve as a result of Brexit being delayed healthcare...

Doctors less likely to be investigated for 'one-off' mistakes under new GMC rules

Doctors less likely to be investigated for 'one-off' mistakes under new GMC rules

The GMC is introducing new measures to reduce the number of full investigations in...

RCGP revokes Sultan of Brunei's honorary title over anti-LGBTQ laws

RCGP revokes Sultan of Brunei's honorary title over anti-LGBTQ laws

The RCGP has revoked the honorary title it awarded the Sultan of Brunei following...

Financial considerations for primary care networks

Financial considerations for primary care networks

Specialist accountant Laurence Slavin highlights the financial issues that practices...

Number of CCGs could be cut by 75% by April 2020

Number of CCGs could be cut by 75% by April 2020

Measures to cut the number of CCGs in England by more than three quarters could be...