Verrucous carcinoma is a rare dermatological disease with an unclear etiology, having a long–term chronic course and quite difficult to treat. With its development, extensive, palm-sized, towering plaques appear on the surface of the skin, mainly of the lower extremities. Diagnosis of carcinoid papillomatosis of the skin of the Gottron is made by examining the patient, studying his anamnesis and histological examination of tissues in the lesion. No etiotropic treatment has been developed, symptomatic and supportive therapy is being carried out using antibiotics, vitamin preparations, antiseptic and cytostatic agents.
Verrucous carcinoma is a chronic skin disease that occurs against the background of long–term inflammatory tissue lesions (eczema, psoriasis and a number of others). It was first described by the German dermatologist G. Gottron in 1932. This condition is quite rare, mainly in middle–aged and older people – the onset of the disease in most cases occurs in the age range of 32-60 years. Men get sick a little more often than women, skin lesions are usually symmetrical, but sometimes single foci can be observed. According to its clinical symptoms, carcinoid papillomatosis of the skin of the Gottron is quite similar to malignant carcinoma, however, no signs of oncological pathology are determined by its careful study. There are also no cases of malignant degeneration of plaques and other rashes with this disease.
The etiology and pathogenesis of this disease are still unclear. It was found out that skin manifestations in the form of plaques occur at the site of long–term dermatological pathologies – psoriasis, lichen planus, eczema, ichthyosis, some forms of skin tuberculosis. Assumptions about the genetic or hereditary nature of this condition have not been confirmed. Some experts support the opinion that this disease is caused by the peculiarities of the reactivity of the body and its tendency to papillomatous growths. At the same time, the tissues react to prolonged permanent injury or irritation of the skin (which occurs with the above diseases) with the development of plaques characteristic of carcinoid papillomatosis of the skin of the Gottron. The addition of saprophytic microflora and secondary infection to this aggravates the pathological process.
The most pronounced and almost the only manifestation of verrucous carcinoma is the formation of plaques of significant size (up to 10-15 centimeters), raised above the surrounding surface by 1-1.5 centimeters. Their predominant localization is the lower extremities in areas that have been subjected to other dermatological diseases. The location of plaques is usually symmetrical, their surface is covered with tumor-like formations and numerous vegetations. They have a dough-like consistency and are separated with an unpleasant odor due to the vital activity of saprophytic microflora. A dirty yellow viscous secret covers the entire surface of the plaque and the spaces between vegetations; drying out, it forms crusts tightly adjacent to the surface. Tumor-like formations with carcinoid papillomatosis of the skin of the Gottron are easily macerated, in which case erosive foci form in their place.
Diagnosis of the disease is carried out on the basis of the results of a dermatologist’s examination, examination of the patient’s anamnesis, histological studies. Examination reveals plaques with a surface resembling cauliflower due to tumor-like nodules and vegetations and covered with dirty yellow secretions and crusts with an unpleasant odor. The lesions in verrucous carcinoma are located symmetrically, in the case of a long course of the disease, erosion and ulcers can be found on their surface at the site of the vegetation that has undergone maceration. During the survey, it turns out that the patient had various inflammatory diseases on the affected areas of the skin for a long time before the development of the present condition. Similar data can be obtained by studying a person’s medical history or his outpatient card.
During skin biopsy and subsequent histological examination of tissues, pronounced acanthosis is detected with the formation of strands that penetrate deep into the dermis in the form of thin processes. Some of them then lose their connection with the epidermis, forming epithelial “islands” and clusters in the dermis. Pronounced pseudocarcinomatous hyperplasia of the epidermis is also detected, atypia characteristic of malignant neoplasms is not detected in the cells. Some of the acanthous strands and epithelial islets undergo keratinization. Also, in the tissues of the pathological focus with carcinoid papillomatosis of the skin of the Gottron, pronounced lymphocytic and histiocytic infiltration is detected. Differential diagnosis of the disease should be carried out with chronic ulcerative-vegetative pyoderma, squamous cell skin cancer, chromomycosis.
Etiotropic treatment of this pathology has not been developed in dermatology, cytostatic drugs, broad-spectrum antibiotics, vitamin remedies are used to relieve symptoms. Of the cytostatics for carcinoid papillomatosis of the skin of the Gottron, prospidin is most widely used. A secondary drug for the treatment of this condition is xanthinol nicotinate, a drug with the ability to improve microcirculation and tissue trophism. Vitamin remedies are necessary to normalize metabolism and improve the regenerative properties of the body, antibiotics help to avoid secondary infection and, according to some reports, also contribute to reducing the severity of symptoms.
Locally, various antiseptic solutions are used for carcinoid papillomatosis of the skin of the Gottron – furacilin, potassium permanganate, etc. Regular lotions with such drugs can somewhat reduce the rate of crusting, reduce the amount of secreted secretions and remove unpleasant odors. Also, according to some reports, local intradermal injections of corticosteroids produced around plaques contribute to recovery. However, in general, this dermatological condition is difficult to treat and does not always respond to the therapeutic measures taken.
Prognosis and prevention
Despite the severity of symptoms and severity of manifestations, this condition rarely poses a threat to the patient’s life – carcinoid papillomatosis of the skin of the Gottron does not degenerate into a malignant neoplasm, the only threat is the risk of secondary infection. It can provoke severe purulent inflammation and toxic shock or sepsis caused by it. But the prognosis regarding recovery is unfavorable – the development of vegetations and plaques can last for many years, then subsiding, then becoming more active. In addition, an unpleasant smell and an unsightly appearance of skin manifestations can cause psychological problems in the patient. For the prevention of carcinoid papillomatosis of the skin of the Gottron, it is necessary to treat dermatological pathologies in a timely and complete manner, which can become the basis for the development of this condition.