Are these lesions manifestations of collagen vascular disease?

DAVID L. KAPLAN, MD—Series Editor
University of Missouri Kansas City, University of Kansas

Case 1:

A collagen vascular disease—which has not yet been differentiated—was recently diagnosed in a
44-year-old woman who has muscle and joint pain. She presents with
lesions on the interphalangeal portion of 3 fingers.

What does this look like to you?

A.  Gottron papules.
B.  Gottron sign.
C.  Proximal nail-fold telangiectasia.
D.  Contact dermatitis.
E.  Warts.


(Answer on next page.)





Case 1: Warts

These lesions are warts, E. Gottron papules are flatter, more violaceous, and typically seen over the joints in dermatomyositis; Gottron sign is erythema over the joints. Proximal nail-fold telangiectasia can be seen in any connective tissue disease but was absent in this patient. Contact dermatitis presents with redness, pruritus, and scale.

The warts were not associated with the underlying disease, which remains undifferentiated. Systemic lupus erythematosus sometimes presents with joint-sparing erythema on the dorsum of fingers in the interphalangeal regions. Hypopigmented areas are noted in discoid lupus erythematosus. Sclerodactyly of scleroderma was not observed in this patient.

The patient’s warts were treated with topical keratolytics; there were no sequelae.