Differential Diagnosis for Hard Growth on Toe
- Single most likely diagnosis
- Fungal infection (e.g., onychomycosis): The patient's presentation of a hard, dry, rough skin lesion on the toe, combined with the initial impression, suggests a fungal infection. The location on the proximal nailfold and the description of the lesion are consistent with this diagnosis.
- Other Likely diagnoses
- Verruca (wart): Given the patient's history of warts on the hands and current self-treatment of a wart on the face, it's plausible that the lesion on the toe could be a verruca. The description of the lesion as hard and dry could be consistent with a verruca, especially if it has been present for some time.
- Corn or callus: The description of the lesion as hard and dry could also suggest a corn or callus, which are common on the feet, especially on areas like the toes that bear pressure.
- Squamous cell carcinoma: Although less likely given the patient's age and lack of specific risk factors mentioned (like prolonged sun exposure or immunosuppression), squamous cell carcinoma can present as a hard, rough lesion and should be considered, especially given the patient's history of treating a lesion on the face.
- Do Not Miss diagnoses
- Melanoma: While the description does not strongly suggest melanoma, any new or changing skin lesion, especially on the foot, warrants consideration of this diagnosis due to its potential severity and the importance of early detection.
- Kaposi's sarcoma: In immunocompromised patients, Kaposi's sarcoma can present as skin lesions. Although the patient's liver condition and unemployment status due to this condition do not directly imply immunocompromise, it's a consideration, especially if the patient has other unmentioned risk factors.
- Rare diagnoses
- Keratoacanthoma: A low-grade, or sometimes considered benign, malignancy that can resemble a wart or a fungal infection but typically has a more rapid growth phase.
- Dermatofibroma: A benign skin growth that can appear as a hard, rough lesion, though it's more commonly found on the legs.
- Subungual exostosis: A bony growth under the nail that can cause a hard lesion, though it's typically painful and associated with nail deformity.