A 32-year-old Nigerian woman presented with dull pain, pruritus, and discoloration of the dorsal aspect of both feet for 18 months. Her medical history included a red blood cell transfusion as a child and 2 uncomplicated pregnancies.
The lesions started as small papules on the dorsal right great toe and left third toe that gradually spread across the dorsum of her feet over the following 12 months. An over-the-counter antifungal ointment was unhelpful. Her primary care physician completed a biopsy, diagnosed verruca plantaris, and prescribed topical salicylic acid twice daily for 4 weeks. The lesions did not improve, and her foot pain worsened. Subsequent treatment with topical liquid nitrogen cryotherapy was ineffective.