Presenting Complaints

The patient presents with concerns about the appearance of warts on his hands.

History of Presenting Complaint

The patient first noticed small, raised bumps on his hands about 3 months ago. The bumps have gradually increased in number and size over time. He reports that the warts are unsightly and he is worried they may be a sign of a more serious underlying condition. The patient denies any pain, itching, or other associated symptoms.

Significant Positives & Negatives For Differentials

Common Warts

Positives:

• Gradual onset and progression of lesions
• Characteristic appearance of warts on the hands
• Patient's young age
• Lack of other concerning symptoms

Negatives:

• None mentioned in the case

Plantar Warts

Positives:

• None mentioned in the case

Negatives:

• Location of the lesions is not on the plantar surface

Verrucous Carcinoma

Positives:

• None mentioned in the case

Negatives:

• Patient's young age
• Lack of other concerning symptoms

Past Medical History

The patient reports no significant past medical history. He has not had any previous skin conditions or infections.

Drug/Medication History

The patient takes no regular medications and denies any recent use of over-the-counter or prescription drugs.

Social History

The patient is a 21-year-old male who lives in the United Kingdom. He is a university student and works part-time at a local retail store. He denies any history of smoking, alcohol, or recreational drug use.

Family History

The patient reports no family history of skin conditions or warts.

Systems Review

The review of systems is otherwise unremarkable, with no other symptoms reported.

Ideas, Concerns & Expectations

The patient is concerned that the warts may be a sign of a more serious underlying condition and is seeking an explanation and treatment.

Case Presentation

Based on the patient's history and physical exam findings, the initial diagnosis is common warts. The key features that support this diagnosis are the gradual onset and progression of the lesions, the characteristic appearance of the warts on the hands, the patient's young age, and the lack of other concerning symptoms. Plantar warts can be ruled out due to the location of the lesions, and verrucous carcinoma is unlikely given the patient's young age and lack of other concerning symptoms. The next steps in management would be to confirm the diagnosis through visual inspection, provide patient education on the benign nature of common warts and the various treatment options, and discuss the patient's preferences for management, which may include observation, topical treatments, or cryotherapy.