Skin disease, don't look if you don't want to vomit

November 8, 2005 10:26 AM

Paging any dermatologists, epidemiologists, or pathology-minded scientists -- any idea what in name of the gods this is? (Probably SFW, but not safe if you want to eat today or at least not wretch).

So a couple of us in the lab have been somewhat fascinated -- more sickened -- by this, but as we work on viruses (and this doesn't look anything like a viral infection) we've been reduced to guesses, mostly in the realm of fungal/lichen or syphilis (in its older more virulent form, as seen on the BBC News) and yaws.

Any ideas?

posted by The Bishop of Turkey to Health & Fitness (25 answers total)

Oh, dear gods, why did I click that?

Looks like lichen to me.
posted by Faint of Butt at 10:31 AM on November 8, 2005

Looks like no modern syphilis manifestation I've ever seen, and I've seen *many* working in STD training. Some sort of lichen/fungus?? I'll ask around.
posted by tristeza at 10:38 AM on November 8, 2005

Thanks, I know you warned me but damn, that was nasty like nasty on steroids.

I agree with Faint of Butt, it does look like lichen. It definitely looks fungal to me.

I would highly doubt that its "Finger lichen good" though.
posted by fenriq at 10:50 AM on November 8, 2005

Agreed that it looks fungal, but a lot of dermatological conditions can. It looks like the skin immediately next to the growths is necrotic, so this is definitely not simply growing ON the skin, but IN the skin to some degree.

I'll go with some really terrifically bad fungal infection as well. Could be a type of melanoma, though.
posted by griffey at 10:57 AM on November 8, 2005

I'm going to say Actinic Keratosis
While the examples I found on the web are not near what your picture shows, the lesion can form keratin horns that are similar.
The disease is usually due to sunlight exposure and is precancerous but it can be due to "exposure to ionizing radiation, hydrocarbons, or arsenicals." (Robbins Pathology) This could explain the severity and concentration in this case.
posted by Corpus Callosum at 10:58 AM on November 8, 2005

Welcome to the joy of DermIS. The closest approximation to that picture seems to be Keratosis Palmoplantaris, but look at all the hand pictures and guess for yourself.
posted by v-tach at 11:16 AM on November 8, 2005

V-tach is more on the nose than I am. The word Actinic ties it to the sun and this appears to be from another cause. The end result of keratosis is an overproduction of keratin by the diseased skin. In severe and untreated cases, this can approximate animal horn material.
posted by Corpus Callosum at 11:29 AM on November 8, 2005

Barnacletosis (unscientific opinion)
posted by desert_roamer at 11:40 AM on November 8, 2005

IANAD, but it looks to me like a case of photoshopitis.
posted by muddgirl at 11:47 AM on November 8, 2005

Response by poster: You know, fenriq, I'm almost a little more sickened by the "Finger Lichen Good" pun than I am the hand.

v-tach: Thanks for the DermIS site -- that is one that we hadn't come across. I think I will browse through those hand pictures and throw up in my mouth a little.
posted by The Bishop of Turkey at 12:04 PM on November 8, 2005

Response by poster: muddgirl: I examined it somewhat closely and didn't see any obvious signs of photoshopping so if it has been, it is a pretty good photoshop job. Also, after looking through a multitude of pathology sites over the last couple of days, I can say that anyone trying to photoshop a picture like this is wasting their time because Nature has already made sure that there is plently that really does look this disgusting.
posted by The Bishop of Turkey at 12:21 PM on November 8, 2005

My county coroner pathologist buddy says they're warts.
posted by sohcahtoa at 12:33 PM on November 8, 2005

It is too symetrical... Obviously fungal/viral but to get to the stage of the photo.....

Are we being tested here??

If I saw this in real life, I wouldn't expect it to be so beautifully photographed. But that's just me, I am not a dermotologist...
posted by Wilder at 1:13 PM on November 8, 2005

The best resource I know of for dermatology photos is the Dermatlas by Johns Hopkins University. I looked at the linked photo for a second and don't want to look again, but if the suggestion of lichens is correct, it could be something like this. My first thought was scabies.
posted by McGuillicuddy at 1:40 PM on November 8, 2005

Oh, obviously graphic pictures including full nudity are available on Dermatlas. You've been warned.
posted by McGuillicuddy at 1:41 PM on November 8, 2005

These aren't HPV/warts, nor AK's, IMO.

When I was around eleven I was hiking along the road on the way to the beach in Maine when I passed a string of kids from a neighboring camp, one of whom had this on his torso and arms. I thought maybe I dreamed it. It was nauseatingly surreal, and seeing that just gave me flashbacks. In seventeen years of med school, residency, and practice I've never seen it since.

Good god.
posted by docpops at 2:25 PM on November 8, 2005

Couple misconceptions: Lichen planus isn't caused by a real lichen. No human diseases are caused by lichens, which are all two organisms: fungus/algae symbionts. Lichen planus is a descriptive name for a non-infectious skin disease.

This isn't HPV warts - too big - or a fungal infection - too little inflammation, no pus - either.

It looks neoplastic to me. Although I'd never heard of it, my money's on palmo-plantar hyperkeratosis as in v-tach's link; which is, apparently, a hereditary neoplastic syndrome. I'll get my dermatologist friend to cast an eye on it.
posted by ikkyu2 at 3:11 PM on November 8, 2005

Hyperkeratoses related to arsenic contamination?

dear god, why did I click on that? Tonight: nightmares.
posted by scody at 4:18 PM on November 8, 2005

Makeup or photoshop. I can't believe someone would let it get that far without having it removed by a doctor.
posted by Hildago at 7:50 PM on November 8, 2005

Let me be the third doc at least to chime in with no freakin' clue what it is. I can say that it doesn't look infectious, and definitely appears more consistent with neoplasia or some kind of hyperkeratotic syndrome. I do like v-tach's link as well, for the best guess. I'm not a dermatologist by any stretch, but I wander around the wards of a major tertiary hospital all day and night and I've honestly never seen anything like it.
posted by drpynchon at 8:48 PM on November 8, 2005

Hildago:I can't believe someone would let it get that far without having it removed by a doctor.

Not if they're from an underdeveloped region with no access to medical care. Millions of people all over the world suffer hideous disfigurement from causes most people (no matter how poor) would be able to take care of in the first or second worlds.
posted by scody at 10:34 PM on November 8, 2005

Wow, I learned something today!
posted by Hildago at 8:38 AM on November 9, 2005

Could it be a burn of some kind, or a chemical reaction?
posted by whatnot at 8:47 AM on November 9, 2005

I think I'd rather just lose the left hand and go with whatever the surgeons will let me have left on the right hand. I wasn't that disgusted at it as much as wondering what it was. I guess I did wince a little, but nothing close to hurling. I hope for his sake it damaged the nerves so he couldn't feel it.
posted by vanoakenfold at 9:09 AM on November 9, 2005

Response by poster: Well, it isn't a chemical burn -- I've had those (concentrated nitric acid) and they either don't leave anything, you just get a normal scar, or you really can't tell. They are pretty much like normal burns, though they can discolor (like, say, silver nitrate burns).

After looking through some of the sites that have been posted here, it does look to me like a hyperkeratotic type of syndrome or arsenic poisoning, though I am still thrown off by what looks like an inflamation around the lesions which would make me think that it is an infection as opposed to the arsenic poisoning (which does seem almost right). And, yeah, it is definitely not warts. Like I said, we are pretty sure it isn't anything viral.

While I can buy the "not doing anything about it" due to the possibility of this being from a third world country or on some lazy bastard, I can't imagine not at least picking at it. My labmate kept exclaiming "JESUS! Just cut the damn hand off!"
posted by The Bishop of Turkey at 10:54 AM on November 9, 2005