Pseudoverrucous Papules

Jenny Nelson, M.D., and Michele Maroon, M.D.

N Engl J Med 2011; 364:e50June 9, 2011

A 53-year-old woman with a history of delusions presented with more than 100 moist, red papules measuring 3 to 6 mm in diameter on the dorsal surfaces of the right hand and wrist (Panel A). For almost a year, she had been having a delusion that someone was injecting fungus into her hand. To protect herself, she had worn a medical examination glove on her right hand at all times over the past 10 months. Analysis of a biopsy specimen produced results consistent with a diagnosis of pseudoverrucous papules. This condition is a form of irritant contact dermatitis that has morphologic and histologic overlap with granuloma gluteale infantum, an occlusive diaper dermatitis. The examination glove fit less tightly on the patient's fingers than on her hand and wrist, which may explain the distribution of the papules. Treatment consisted of removing the glove. At a follow-up visit 6 weeks later the papules were significantly smaller and fewer in number (Panel B). On examination at a follow-up visit at 3 months, the papules were almost completely resolved, with only a plaque of erythema remaining.

Jenny Nelson, M.D.

Michele Maroon, M.D.

Geisinger Medical Center, Danville, PA