Lee Windebank
Age: 24 years old male
Full Case
Patient’s Data
Patient’s name: Lee Windebank
Age: 24-year-old male
Past medical history
- Nil
Drug and Allergy history
- No drug history
- No known drug allergy
Recent consultation/Notes
- No recent notes
Patient has sent in a photo of a skin lesion or rash for review
Patient is here to discuss rash/lesion
Patient's Story (Role player’s brief)
Patient’s Story
You are Lee, aged 24, and you’ve booked a telephone consultation after sending in a photo of a skin lesion.
You first noticed the bump/rash on your right index finger (first finger) about 7 weeks ago. It has grown slightly in size over time. It is not painful, not itchy but feels a bit rough and is slightly raised.
Only Provide the below If Asked
The rash is not present anywhere else on your body
You have not been in contact with anyone with a similar rash
Social History: Non-smoker, No alcohol use. You live with parents and sister
You work as a chef in an Italian restaurant.
Idea: You’re not sure what’s causing it
Concern: You’re worried it might be infectious, especially since you work as a chef and want to return to work
Expectation: You want the doctor to tell you what the rash is and whether you can go back to work.
Questions for the doctor
“Can this skin condition (if it’s a wart) spread?” “Can I still work as a chef?”
Marking Scheme
Data Gathering and Diagnosis
- Ask about the onset of the rash/lesion
- Ask about the location of the rash and whether it is present anywhere else on the body
- Ask if the rash is getting better, worse, or staying the same over time
- Ask if the rash is itchy or painful
- Ask if there has been any bleeding, cracking, or discharge from the lesion
- Ask if the patient has had contact with anyone with a similar rash
- Ask if the patient has been unwell recently (e.g. flu-like symptoms, sore throat, fever) prior to onset
- Ask if the patient has had this type of rash before
- Ask if the patient has a history of eczema or other skin conditions
- Ask if the patient has started any new medications recently
- Explore the patient’s ideas, concerns, and expectations (ICE)
- Ask about occupation and social history
- Make a working diagnosis of warts
Example of explanation to patient
Lee, thanks again for getting in touch and sending the photo. Based on what you’ve told me and what I can see, this looks like a wart — a small, harmless skin growth caused by a virus/viral bug called human papilloma virus (HPV)
You can get it through direct skin contact with someone who has a wart, or by touching surfaces where the virus might live, like floors in communal showers, changing rooms, or swimming pools. Sometimes it’s hard to know exactly where or when you picked it up, as it can take weeks for the wart to appear after exposure
It’s nothing dangerous, but I understand how frustrating it can be, especially because you work with your hands. Warts often go away on their own, though this can take a few months.
Since the wart is on your right index finger and you work as a chef, we do need to be a bit cautious to keep things hygienic. You can still go to work, but it’s important to keep the wart covered with a clean, waterproof dressing at all times during food prep. To be extra safe, you could also wear disposable gloves over the dressing while cooking, this adds another layer of protection and helps stop the virus from spreading.
If you’d like to treat it, you can try over-the-counter wart treatments from any pharmacy, such as salicylic acid creams, which help break down the wart over time and can be used for up to 12 weeks. These are easy to apply, and the pharmacist can guide you on which to use.
If it doesn’t get better or starts causing you problems, we can refer you for a treatment called cryotherapy. This involves applying a cold spray to the wart to freeze and destroy the tissue, which helps it to fall off over time.
Also, try not to scratch or pick at the wart, doing so can cause the virus to spread to other parts of your body or even to other people.
If the wart starts to hurt, bleed, or spreads further, let us know. We can explore other options like freezing treatment if needed. But for now, you’re safe to work with the right precautions, and I’m happy to support you with any next steps.
Management
Management
- Offer face-to-face review for use of dermatoscope for a closer look, if there is any uncertainty about the nature of the skin lesion.
- If confident in the diagnosis from the photo and history, reassure that a face-to-face consultation may not be necessary.
- Explain that warts are harmless and usually clear up on their own, but it may take several months.
- Inform patient that warts usually spread through direct contact with someone else’s skin, or by touching surfaces that have been contaminated, like floors in swimming pools or shared shower areas
- Suggest trying an over-the-counter salicylic acid treatment, which is available from most pharmacies.
- Advise that warts can spread, so certain precautions are needed to reduce this risk.
- Advise that he can continue working as a chef, provided the wart is covered with a waterproof dressing to avoid direct contact with food, utensils, or kitchen surfaces
- Recommend wearing disposable hygienic gloves over the dressing for an added layer of protection while working.
- Reassure that transmission through food is unlikely, but good hand hygiene is still essential
- Advise not to scratch or pick at the wart, as this can cause the virus to spread to other parts of the body.
- Signpost or send a leaflet from the NHS website with more information about warts
- Advise the patient to contact the surgery if the wart becomes painful, bleeds, spreads, or does not improve over time.
Learning point from this station:
This station highlights the importance of recognising and managing common viral skin conditions such as warts, particularly when they impact a patient’s occupation — in this case, a food handler. Warts are caused by the human papilloma virus (HPV) and, while generally harmless, they can spread through direct contact or via contaminated surfaces such as shared showers or swimming pool floors.
A key clinical skill is the ability to make a confident remote diagnosis when supported by a clear history and good image quality. However, if there is any diagnostic uncertainty, it is appropriate to offer a face-to-face review, especially if the lesion is atypical or not resolving.
Another important aspect is addressing the patient’s concern about returning to work. If the wart is on a hand or finger, advice should be given on using waterproof dressings and possibly disposable gloves to reduce the risk of contamination. However, in the context of the exam, if you are not completely sure about whether the patient can return to work safely with the lesion, the safe and professional response is to explain that you will check the relevant guidance and get back to them. This shows clinical responsibility and patient safety awareness.
Patients should also be advised not to scratch or pick at the lesion, to reduce the risk of spread, and can be offered pharmacy treatments such as salicylic acid preparations.