Parents of a 7-year-old girl presented with complaints of asymptomatic hyperpigmented lesion on the left side of her face since 4 years following a roadside accident. Upon close examination multiple hyperpigmented flat topped papules measuring 1 × 1 mm arranged in parallel rows with many coalescing to form a brownish plaque mimicking post laceration hypertrophic scar were seen [Figure 1a]. Similar lesions were not seen elsewhere on the body. Dermoscopy revealed well-defined brownish globules with pinpoint red dots suggestive of verrucae. Based on clinical and dermoscopic findings a diagnosis of verruca plana was made [Figure 1b]. The child was prescribed topical retinoids with oral zinc acetate which led to marked improvement in lesions after a span of 6 weeks [Figure 1c]. Verruca plana are skin colored to hyperpigmented flat papules occurring commonly due to HPV type 3, 10 and 27. In this case, trauma disrupted skin barrier causing seeding of viral agents into skin with autoinoculation along the lines of wound leading to peculiar shape of a post-traumatic laceration. Pseudo-koebner phenomenon is appearance of similar lesions around the original lesion due to autoinoculation caused by trauma.[1] The resulting lesion may mimic varied entities emphasizing the role of careful physical examination.
Figure 1.
(a) multiple hyperpigmented flat topped papules measuring 1 × 1 mm arranged in parallel rows with many coalescing to form a brownish plaque mimicking post laceration hypertrophic scar (b) Well-defined hyperpigmented globules with pin point red dots (Heine Delta 10x dermoscope under non polarized view) (c) decreased pigmentation and flattening of papules after 6 weeks of topical tretinoin 0.025%
Limitation
Histopathology of the lesion could not be done due to uncooperative child.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published, and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Reference
- 1.Sidharth S, Rahul A, Rashmi S. Cosmetic warts: Pseudo-koebnerization of warts after cosmetic procedures for hair removal. J Clin Aesthet Dermatol. 2015;8:52–6. [PMC free article] [PubMed] [Google Scholar]