Podophyllin reaction mimicking Bowen's disease in a patient with delusions of verrucosis.

A 40-year-old woman presented with a delusion of warts on the forehead, for which she was applying podophyllin toxin. A skin biopsy was taken, which showed prominent mitotic figures in the basal and suprabasal layers of the epidermis and apoptotic keratinocytes. Histopathologically Bowen's disease was suspected, but was discounted after clinicopathological correlation was obtained and showed absence of epidermal atypia or disorganization. This case demonstrates the histological resemblance of podophyllin reaction to Bowen's disease. Differentiation of self-inflicted from organic skin disease may be difficult, especially where histopathological findings are confounded by cutaneous application of toxins.

Primary care treatment approach to nongenital verruca.

Nongenital verruca is a common ailment frequently encountered in the primary care setting. Although greater than half of verruca resolve spontaneously within a 2-year period, many have a propensity to spread and cause considerable discomfort if untreated. This characteristic makes it vital for the clinician to become competent in assessment and treatment of verruca. This article discusses etiologic and epidemiologic factors, diagnosis and prevention considerations, folk remedies, and common treatment options for the management of verruca. Included is a patient-teaching handout to offer the patient when dual office and home therapy is chosen. This article also reviews the newest treatment option, Cimetidine (Tagamet). Current research with this H2 antagonist offers hope for easier and less costly management of recalcitrant verruca.