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E-IJD® - CORRESPONDENCE
Year : 2022  |  Volume : 67  |  Issue : 3  |  Page : 317
Verrucous epidermal nevus with unusual presentations: A case series of 5 cases


1 Department of Dermatology, Esic Medical College and Hospital, Alwar, Rajasthan, India
2 Department of Dermatology, Jhalawar Medical College, Jhalawar, Rajasthan, India
3 Department of Dermatology, Dr. Sn Medical College, Jodhpur, Rajasthan, India

Date of Web Publication22-Sep-2022

Correspondence Address:
Shivani Saini
Department of Dermatology, Esic Medical College and Hospital, Alwar, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijd.ijd_880_21

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How to cite this article:
Saini S, Agarwal S, Yadav C, Sharma S. Verrucous epidermal nevus with unusual presentations: A case series of 5 cases. Indian J Dermatol 2022;67:317

How to cite this URL:
Saini S, Agarwal S, Yadav C, Sharma S. Verrucous epidermal nevus with unusual presentations: A case series of 5 cases. Indian J Dermatol [serial online] 2022 [cited 2022 Oct 6];67:317. Available from: https://www.e-ijd.org/text.asp?2022/67/3/317/356769




Sir,

Verrucous epidermal nevus is a well-known benign, non-inflammatory epidermal nevus with the onset usually at birth or within the first years of life. It represents blaschkoid hamartomas of the skin from mosaic post-zygotic mutations.[1] They may present anywhere in the body but typically occur on the trunk or extremities.[2] Although it has benign nature, malignant changes in VEN have also been reported.[3],[4]

Very few cases are reported at unusual sites, and we have prepared a case series of 5 cases with a rare site of occurrence and multidermatomal pattern of VEN.

We are reporting 5 cases of biopsy-proven VEN here. There were 3 males and 2 females with the age varying from 3 to 21 years. A clinical description of the individual case is shown in [Table 1].
Table 1: Tabulated description of unusual types of VEN

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All patients gave a history of light brown- to dark brown-coloured growth on their body since a few weeks after birth and spreading it with the growth of age. It was asymptomatic in 3 cases, while but mildly itchy in 2. No other associated features were found. Family history was found positive in 3 cases. Marriage was non-consanguineous in all cases and baby was born by normal vaginal delivery in 4 cases and caesarean section in 1 case. Differential diagnoses kept were inflammatory linear verrucous epidermal nevus, genital warts, linear lichen planus, and lichen nitidus.

On local cutaneous examination, morphology was similar in all cases. There were discrete to closely arrange, verrucous, skin-coloured to hyperpigmented papules and some coalescing to form plaques [Figure 1] and [Figure 2]. To confirm the diagnosis, a skin biopsy from the lesion was done and it showed hyperkeratosis, parakeratosis, orthokeratosis at a few places, papillomatosis and acanthosis [Figure 3]. Routine blood investigations were within normal limits. Our limitation was that mutation analysis of genes could not be performed.
Figure 1: Pictures showing clinical morphology of VEN having unusual presentations of cases 1, 2, 3 (a-c)

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Figure 2: Picture showing VEN of cases 4 & 5 (a and b)

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Figure 3: Histopathology of VEN of one patient showed hyperkeratosis, parakeratosis, orthokeratosis at few places, papillomatosis, acanthosis [H & E stain, a (10×), b (40×)]

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It isolated VEN from other kept differentials. They were explained about the nature and course of the disease and given symptomatic treatment wherever required. They were advised for surgical or laser ablation if required cosmetically by the patients.

Patients usually seek advice for cosmetic reasons. Treatment options available include a combination of retinoic acid and 5-fluorouracil, salicylic acid, calcipotriol, cryosurgery, dermabrasion and electrocautery, CO2 laser, Erbium YAG laser and Nd: YAG laser.[5]

There have been very few cases of unusual presentation of VEN reported [Table 2]. However, our case is worth reporting due to its rarity and has never been reported as per our knowledge. It differentiated from inflammatory variety due to its non-pruritic nature.
Table 2: Case reports showing unusual presentations of VEN

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Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.[9]



 
   References Top

1.
Paller AS, Syder AJ, Chan YM, Yu QC, Hutton E, Tadini G, Fuchs E. Genetic and clinical mosaicism in a type of epidermal nevus. N Engl J Med 1994;331:1408-15.  Back to cited text no. 1
    
2.
Rogers M, McCrossin I, Commens C. Epidermal nevi and the epidermal nevus syndrome. A review of 131 cases. J Am Acad Dermatol 1989;20:476-88.  Back to cited text no. 2
    
3.
PiersonD, Bandel C, Ehrig T, Cockerell CJ. Benign epidermal tumors and proliferations. In: Bolognia JL, Jorizzo JL, Rapini RP, editors. Dermatology. 1st ed. Philadelphia: Mosby; 2003. p. 1697-720.  Back to cited text no. 3
    
4.
Riad H, Mansour K, Sada HA, Naama KA, Shaigy AA, Hussain K. Fatal metastatic cutaneous squamous cell carcinoma evolving from a localized verrucous epidermal nevus. Case Rep Dermatol 2013;5:272-82.  Back to cited text no. 4
    
5.
Attia A, Elbasiouny MS. Treatment of verrucous epidermal nevus using long pulsed Nd: YAG laser. Egypt Dermatol Online J 2010;6:2.  Back to cited text no. 5
    
6.
Kaur T, Kataria AS, Sethi A. Verrucous epidermal nevus on female genitalia: A rare presentation. Indian J Paediatr Dermatol 2015;16:110-1.  Back to cited text no. 6
  [Full text]  
7.
Bhagwat PV, Tophakhane RS, Shashikumar BM, Naidu V. Dermatomal giant nevus unius lateralis. Indian J Dermatol Venereol Leprol 2009;75:419-21.  Back to cited text no. 7
[PUBMED]  [Full text]  
8.
Bandyopadhyay D, Saha A. Genital/perigenital inflammatory linear verrucous epidermal nevus: A case series. Indian J Dermatol 2015;60:592-5.  Back to cited text no. 8
[PUBMED]  [Full text]  
9.
Narang T, Kanwar A. Verrucous epidermal naevus on penis, Indian J Dermatol 2006;51:222-3.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2]



 

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