Presenting Complaints

The patient presents with multiple, painless growths on his hands and feet that have been present for several months.

History of Presenting Complaint

The patient, a 42-year-old male from Egypt, reports noticing the first growth on his right hand about 6 months ago. Over the next few months, he has developed several more similar growths on his hands and feet. The growths are not painful, but he is concerned about their appearance and the possibility of them spreading. He denies any associated itching, redness, or other symptoms. He has not tried any over-the-counter treatments.

Significant Positives & Negatives For Differentials

Verrucae (Common Warts)

Positives:

• Multiple, painless growths on hands and feet
• Gradual onset over several months
• Viral etiology
• Occupational exposure to dirt and manual labor

Negatives:

• No associated itching, redness, or other symptoms
• No history of previous skin conditions or infections

Molluscum Contagiosum

Positives:

• Painless skin growths
• Viral etiology

Negatives:

• Typically smaller, dome-shaped lesions
• Lesions often have a central umbilication
• Lack of widespread distribution on hands and feet

Seborrheic Keratosis

Positives:

• Painless skin growths
• Gradual onset

Negatives:

• Typically appear on the trunk, face, or scalp
• Lesions are often waxy, stuck-on appearance
• Lack of widespread distribution on hands and feet

Skin Tags

Positives:

• Painless skin growths

Negatives:

• Typically appear on the neck, armpits, or groin
• Lack of widespread distribution on hands and feet
• Skin tags are usually pedunculated

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 antibiotic or steroid use.

Social History

The patient works as a construction worker and reports frequent exposure to dirt and manual labor. He denies any recent travel outside of Egypt. He is married with two children and lives in a small village.

Family History

The patient reports no family history of similar skin conditions or other dermatological issues.

Systems Review

The patient denies any other symptoms, including fever, chills, weight loss, or changes in appetite.

Ideas, Concerns & Expectations

The patient is concerned that the growths may be contagious and is worried about the cosmetic appearance. He hopes the doctor can provide a diagnosis and effective treatment.

Case Presentation

Based on the patient's history, physical exam findings, and the comprehensive review of the differential diagnoses, the most likely diagnosis is verrucae (common warts). The multiple, painless growths on the hands and feet, gradual onset, viral etiology, and occupational exposure support this diagnosis. Other conditions like molluscum contagiosum, seborrheic keratosis, and skin tags can be reasonably excluded based on the clinical presentation.