10yr old with lupus and osteopoenia

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Hi,

I work with a Nurse whose daugther who we'll call 'V' aged 10 came to see me last year with what her mum described as a lump in her foot. She has Lupus, and osteopoenia. Treatment consists of prednisolone, azothioprine, calcichew and risidronate.

There were dispersed small verrucae pedis over both feet, and a small flat hard circular disc (size of .5cm) proximal to left 1st MTPJ roughly where you'd expect to find the sesamoids within the skin of the foot. This disc could be tipped in all planes but was firmly held within the layers of the skin, and did not seem attached to any other structures. The disc causes extreme pain for this young lady, particularly during term time with the various school activities. I asked for a GP within the prace to consult, and he suggested referral to a paediatritian. As there was a pending appointment at Great Ormond Street, it was recommended she get a referral there. Great Ormond St Hospital called them 'lesions'.

No action has been taken, and 'V' still in great discomfort. At the initial appointment I made some felt pads to help offload the area, and have since provided felt to mum and this does seem to help.

Also because the verrucae are adding to problem, I debrided back, treated with salactol and zinc oxide tape, and suggested mum continues the treatment. Apparently this has worked with some success and just as it looks as if the verrucae have disappeared to nothing, within a few days they're back with a vengance.

Have not seen 'V' since, but have weekly updates from mum. Mum is considering cryotherapy for verrucae treatment, but I have advised to hold fire on that until I have posted here to see if there is suggestions on permanent treatment you could advise, notwithstanding that the VP's could resolve on their own, but this is a little girl with enough problems going on for the time being.

Would also appreciate any ideas you may have about what this disc may be.

Hopefully waiting,
Jacqui

 

It may be a rare form of Discoid LE. The lesions can present on the toes and mimic the morphology of verrucous type lesions. Have you considered biopsy before further treatment?

 

Thanks, having checked out discoid LE and can definitely say that the lesions are not these, they are definitely verrucae. Perhaps I was misleading by using the term disc for other complaint, but there isn't another apt word for it. It feels like a hard piece of cartilege held within the layers of the skin, that is roughly discoid in shape, and able to be tilted in all planes but does not travel within the layers of the skin. No I have not done a biopsy, as I only saw her once last year, the gp consulted and she was referred to GOSH during the next appointment. Regular conversations with her mum have led me to ask here for help.
Jacqui

 

I would certainly consider biopsy before any definitive treatment.