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 Table of Contents  
ONLINE ONLY ARTICLES - CASE REPORT
Year : 2022  |  Volume : 6  |  Issue : 2  |  Page : 149

Adult-Onset linear verrucous epidermal nevus in an Indian male


1 Department of Dermatology, Venereology and Leprosy, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
2 Department of Dermatology, Venereology and Leprosy, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal; Department of Dermatology, Venereology and Leprosy, Kanachur Institute of Medical Sciences, Mangaluru, Karnataka, India
3 Department of Pathology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India

Date of Submission16-Dec-2020
Date of Decision12-Feb-2021
Date of Acceptance07-May-2021
Date of Web Publication26-Aug-2022

Correspondence Address:
U K Sudhir Nayak
Department of Dermatology, Venereology and Leprosy, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal - 576 104
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cdr.cdr_138_20

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  Abstract 


Verrucous epidermal nevus is the most common form of epidermal nevi with usual onset at birth or early life. Adult onset is rare, and we report a case of verrucous epidermal nevi with onset in the fourth decade, dermatoscopy and histopathology of which were consistent with verrucous epidermal nevi.

Keywords: Adult onset, dermatoscopy, verrucous epidermal nevus


How to cite this article:
Sudhir Nayak U K, Shenoi SD, Singh R, Pai K. Adult-Onset linear verrucous epidermal nevus in an Indian male. Clin Dermatol Rev 2022;6:149

How to cite this URL:
Sudhir Nayak U K, Shenoi SD, Singh R, Pai K. Adult-Onset linear verrucous epidermal nevus in an Indian male. Clin Dermatol Rev [serial online] 2022 [cited 2022 Oct 6];6:149. Available from: https://www.cdriadvlkn.org/text.asp?2022/6/2/149/354742




  Introduction Top


Verrucous epidermal nevus is one among the most common of all keratinocytic nevi and is often present at birth. Occasionally, onset may be seen in early childhood or rarely adolescence. Onset in adults is extremely rare. Epidermal verrucous nevi start as pinkish or slightly pigmented raised lesions, which tend to become darker and warty with increasing age. Adult onset of verrucous epidermal nevus is relatively rare and hardly reported.


  Case Report Top


A 34-year-old male presented with an asymptomatic verrucous lesion over the right side of the neck of 4 years duration. Lesion started as erythematous lesion which gradually progressed to become verrucous. There was no history suggestive of trauma, discharge, trauma, or similar lesions elsewhere. The patient was certain of the duration of lesion and the absence of any lesion at birth or childhood over the affected area. Examination showed a 6 cm × 5 cm hyperpigmented verrucous plaque on the right side of the neck [Figure 1]. Cutaneous examination was otherwise unremarkable. Dermatoscopy was done which showed gyri and sulci with comedones and milia.
Figure 1: Linear epidermal verrucous nevus on the neck

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Biopsy for histopathology showed hyperkeratosis, moderate acanthosis, papillomatosis, with intervening invaginations showing laminated hyperkeratosis, mild increase in melanin pigment in the basal layer, and perivascular chronic inflammatory infiltrate [Figure 2] and [Figure 3]. A final diagnosis of late-onset linear epidermal verrucous nevus was made.
Figure 2: Acanthosis, papillomatosis with intervening hyperkeratosis (H and E, ×40)

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Figure 3: Increased melanin in basal layer (H and E, ×2000)

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  Discussion Top


Verrucous epidermal nevi often present at birth, although onset may be seen in early childhood. Late onset of development is relatively rare and hardly reported. Verrucous epidermal nevi start as pinkish or slightly pigmented raised lesions, which tend to become darker and warty with increasing age.[1] Dermatoscopy tends to show the presence of comedone-like openings and milia-like cysts which were seen in our patient. The oldest case of verrucous epidermal nevus had onset at the age of 61.[2] The other oldest age at onset was reported at 55 years.[3] In the Asian continent, onset at the age of 33 has been reported in a Korean female.[4] Late onset at the age of 20 along with facial hemihypertrophy and hypertrichosis has been reported in an Indian patient.[5] In our patient, the age of onset was reported at 30 years. Topical tretinoin and 5-fluorouracil have been tried in the management of epidermal verrucous nevus. Surgical modalities are often the preferred line of management as the response to medical line of management is often unsatisfactory. The surgical modalities that have been used include dermabrasion, electrocautery, radiofrequency ablation, cryosurgery, and LASERs.[1] Recurrence postprocedure is common. Surgical excision with grafting is considered the definitive treatment.

Our patient was different in that the onset of presentation was in the fourth decade of life. Hence, it is prudent to consider the possibility of epidermal nevus in the differential diagnosis of linear late-onset lesions and confirm the same by histopathological examination.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Velaskar S. Nevi and other developmental defects. In: Sacchidanand S, Oberai C, Inamadar A, editors. IADVL Textbook of Dermatology. 4th ed. Mumbai: Bhalani Publishing House; 2015. p. 286-9.  Back to cited text no. 1
    
2.
Kim R, Marmon S, Kaplan J, Kamino H, Pomeranz MK. Verrucous epidermal nevus. Dermatol Online J 2013;19:3.  Back to cited text no. 2
    
3.
Adams BB, Mutasim DF. Adult onset verrucous epidermal nevus. J Am Acad Dermatol 1999;41:824-6.  Back to cited text no. 3
    
4.
Kim IS, Choi SY, Park KY, Li K, Kim BJ, Seo SJ, et al. Adult onset of nevus unius lateris. Ann Dermatol 2012;24:480-1.  Back to cited text no. 4
    
5.
Saritha M, Chandrashekar L, Thappa DM, Ramesh A, Basu D. Late onset epidermal nevus with hypertrichosis and facial hemihypertrophy. Indian J Dermatol 2014;59:210.  Back to cited text no. 5
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