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10-Year-Old Boy with Multi-finger Asymptomatic Lesions

Can you diagnose this case?

David L. Kaplan 2014 Series Editor @ University of Missouri – Kansas City School of Medicine

Signs and Symptoms

The mother of a 10-year-old boy brings him in for evaluation of his moles (which are all benign). During the visit, the mother asks about the lesions on the first 2 knuckles of his right hand; she initially noticed them several months earlier. The boy is otherwise healthy.

What is your clinical impression?

Choose one to reveal diagnosis and discussion

Warts
Psoriasis
Lichen planus
Dermatomyositis
Trauma

Answer: Trauma (knuckle biting)

See the full case at Consultant360

Further questioning revealed that the patient had a “nervous,” or compulsive, habit of chewing and biting on his knuckles, especially during stressful situations at school.

Warts would have a more verrucous appearance, and psoriasis would be more erythematous and scaly. Lichen planus is characterized by polygonal purplish papules, which are unlike the changes seen here. Dermatomyositis can produce erythematous papules overlying the joints of the hands; however, these lesions are associated with proximal muscle weakness, which was absent in this healthy 10-year-old boy.

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