Differential Diagnosis for a Lesion of the Big Toe Containing HPV
- The presence of Human Papillomavirus (HPV) in a lesion of the big toe suggests a viral etiology, likely related to a wart or other HPV-related condition.
Single Most Likely Diagnosis
- Verruca Vulgaris (Common Wart): This is the most likely diagnosis given the presence of HPV in a lesion on the foot, particularly on the big toe. Verruca vulgaris is a common condition caused by HPV infection, leading to a benign growth on the skin.
Other Likely Diagnoses
- Verruca Plantaris: Similar to verruca vulgaris but specifically located on the sole of the foot (plantar surface), which could include the area around the big toe. The presence of HPV supports this diagnosis.
- Bowenoid Papulosis: A rare condition associated with HPV infection, characterized by the presence of multiple small, flat, pigmented lesions. Although less common, it remains a consideration in the differential diagnosis.
Do Not Miss Diagnoses
- Squamous Cell Carcinoma (SCC): Although less likely, it is crucial not to miss this diagnosis. SCC can be associated with HPV infection, especially in immunocompromised individuals. A biopsy is essential to rule out this potentially deadly condition.
- Keratoacanthoma: A low-grade, rapidly growing tumor that can resemble SCC. It is essential to distinguish between keratoacanthoma and SCC due to their different management and prognoses.
Rare Diagnoses
- Epidermodysplasia Verruciformis: A rare genetic disorder characterized by an abnormal susceptibility to HPV infections, leading to the development of multiple types of skin lesions, including warts and potentially malignant lesions.
- Focal Epithelial Hyperplasia (Heck's Disease): A rare condition associated with HPV types 13 and 32, characterized by multiple small, soft, and painless papules in the oral mucosa but can occasionally be found on the skin, including the feet.