PMC7975484_01
Numerous skin-colored papules in a widespread distribution over the bilateral
lower extremities.
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Physical exam was remarkable for numerous tan-colored, verrucous papules on the head, trunk, and extremities (Figure 1).
(a) Papillomatosis and coarse hypergranulosis prominent on the sides of the
papilla with "church spire" tiered parakeratosis, and accentuation of
papillary dermal vessels (H&E 40x). (b) Punctate regions of intracorneal
hemorrhage within the tips of the papillae altogether diagnostic of verruca
vulgaris (H&E 400x).
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Histopathologic analysis was consistent with HPV infection (Figure 2) and polymerase chain reaction confirmed the presence of several HPV types including HPV types 2, 3, 16, 66, 93, 98, and 150.