A 51 year old man attends a clinic with cellulitis. He has a history of psoriasis but hasn’t had any active psoriatic lesions for over 10 years. Whilst you are examining him and assessing the cellulitis, you notice numerous dark/purple growths on his foot. Several of them appear almost verruca-like. They are not painful, and are present on both sides of the feet. The man states they have been present for about a year. There are no signs of psoriasis on examination.
- What is the diagnosis?
- What further tests are required?
Answers and discussion will be posted in a couple of weeks….
- The lesions are typical of Kaposi’s sarcoma.
- Both the Kaposi’s and the cellulitis may be suggestive of an HIV infection. He needs an HIV test.
Warty growths can be seen in many skin conditions, including viral warts, seborrheic keratosis, squamous cell carcinomas, and Kaposi’s. Raised dark/purple lesions may be seen in lichen planus, cutaneous sarcoid, mycobacterial infection and Kaposi’s. So the 2 features together make Kaposi’s the most likely diagnosis.
The most important part of treating Kaposi’s is ART, and often lesions will get smaller as the CD4 count improves. In some cases, this may be the only treatment needed for Kaposi’s. However, if there are other symptoms such as pain or swelling, then other treatments may benefit. If there are only a few small lesions, then topical retinoids (benzyl peroxide) may help. The other option if lesions are very painful, or if lesions are problematic in the mouth or anus, is a referral for radiotherapy (depending on availability). Chemotherpay can also be considered for the most severe/numerous/symptomatic lesions, but again this would depend very much on local availability.
Kaposi’s may look different on African skin, so here are a few examples