The first signs of epidermodysplasia verruciformis are encountered in early childhood when the cell-mediated immunity cannot effectively fight against HPV [1] [2] [3] [4] [5] [6]. The hallmark of this condition is the appearance of macules strikingly similar to those seen in pityriasis versicolor (commonly known as Tinea) [1] [3]. They are flat, hyperpigmented, and exhibit scaling [1] [3]. The upper extremities, the trunk, and the head and neck area are the sites where macule appear [1] [3]. A wart-like papule is also a frequent cutaneous manifestation [1] [3]. Both lesions pose a marked risk for the patient due to their ability to transform into malignant tumors [1] [3]. Approximately 20-30 years is necessary for these lesions to convert into a malignant tumor and most commonly identified types are Bowen's disease and invasive squamous cell carcinoma [1] [2] [3]. Tumors develop on sun-exposed skin (the forehead is observed as the predominant location) and it is thought that prolonged exposure to ultraviolet light promotes the transformation of benign lesions into a malignant variant [1]. Fortunately, metastatic spread of neoplasias is very rare [1]. In addition to macules and warts, other notable cutaneous features are plaques that resemble seborrheic keratosis, whereas mucous membranes remain intact [1] [6]. Despite the known genetic background of epidermodysplasia verruciformis, several studies have used the term "acquired epidermodysplasia verruciformis" to illustrate the occurrence of this condition in patients who are immunocompromised from other conditions [3] [6]. Furthermore, psoriasis and human immunodeficiency virus (HIV) infection have even associated with this cutaneous disorder [3] [6].

• Refractory Anemia

  At this time, severe refractory anemia and neutropenia were observed, and bone marrow smears showed hypercellularity with abnormal dysplastic megakaryocytes. The cytogenetic pattern showed abnormalities involving trisomy of chromosomes 8 and 21. [ncbi.nlm.nih.gov]

• Increased Susceptibility to Infections

  Mutations in EVER1 and EVER2 have been clearly associated with an increased susceptibility to cutaneous beta HPV infections in EV patients ( 4 ). [jvi.asm.org]

• Darkly Pigmented Skin

  We performed HPV typing of biopsied cysts with polymerase chain reaction for a patient with darkly-pigmented skin, epidermodysplasia verruciformis (EV) and more than 250 photodistributed cysts. [ncbi.nlm.nih.gov]

• Neglect

  Vinetz, A misdiagnosed infection mimicking “tree man disease”, PLOS Neglected Tropical Diseases, 11, 6, (e0005543), (2017). S.‐L. Li, L.‐N. Duo, H.‐J. Wang, W. Dai, E.‐Y.H. Zhou, Y.‐N. Xu, T. Zhao, Y.‐Y. Xiao, L. Xia, Z.‐H. Yang, L.‐T. Zheng, Y.‐Y. [doi.org]

Although epidermodysplasia verruciformis is very rarely encountered in the general population, a presumptive diagnosis can be made solely on clinical criteria. For this reason, it is necessary to perform a detailed physical examination and obtain a thorough patient history. During the examination, the typical localization of lesions, their appearance, and characteristics may significantly narrow the differential diagnosis. Conversely, the onset of cutaneous lesions and the presence of similar complaints in parents or close relatives should be covered during the interview. As soon as clinical criteria are met, examination with a dermatoscope and subsequent histopathological studies should be sought [1] [6]. Enlarged keratinocytes with a pale blue cytoplasm in stratum spinosum is a somewhat specific findings in epidermodysplasia verruciformis, while the presence of keratohyalin granules in stratum granulosum and parakeratosis of stratum corneum may also be noted [1]. A definitive diagnosis is made if mutation of EVER1 and EVER2 genes on chromosome 17 are identified, with up to 75% of patients yielding a positive result [1].

• Anergy

  Impairment of CMI was manifested by the cutaneous anergy to a variety of common skin antigens and, by the reduction of the lymphocyte transformation to PHA. [ncbi.nlm.nih.gov]

  […] cytotoxicity of peripheral blood lymphocytes against target cells transfected with epidermodysplasia verruciformis-specific human papillomavirus type 8 L1 DNA sequences, 2004) Patients with mixed HPV or HPV type 3 or HPV 5 infection may demonstrate cutaneous anergy [flipper.diff.org]

• Lymphopenia

  Like the previously described patient, our proband also presented with CD4+ T cell lymphopenia, impaired T cell proliferation to mitogens and antigens, reduced NK cell function, and EBV-associated lymphoma. [ncbi.nlm.nih.gov]

  Several epidermodysplasia verruciformis variants have been described, and the majority of these cases occur in association with immunosuppression, such as HIV infection, organ transplantation, or idiopathic lymphopenia. [23] Generalized verrucosis (GV [emedicine.com]

• Antinuclear Autoantibodies

  This progressed to a lupuslike syndrome with lichenoid, violaceous, flat-topped papules in a malar distribution and positive antinuclear autoantibodies. [ncbi.nlm.nih.gov]

Bajandar’s condition returned after he interrupted treatments in May 2018. His doctors requested that he return for treatment many times. [en.wikipedia.org]

After two rounds of the PDT treatment, the skin lesion disappeared and a skin biopsy confirmed the efficacy of the treatment. This method was simple, less invasive than other treatments, and achieved a satisfactory cosmetic result. [ncbi.nlm.nih.gov]

Management and treatment Although permanent cure of EV cannot be achieved by any therapy at present, described treatment modalities include cryotherapy, topical imiquimod and 5-fluorouracil, systemic retinoids, interferon alpha, and 5-aminolevulinic acid [orpha.net]

Tree Man Before and After Treatment Pictures Dede Koswara with tree man illness. (Before treatment.) Dede Koswara after treatment. [skincare.net]

Prognosis Prognosis is favorable since skin tumors appear progressively and metastases are uncommon. The documents contained in this web site are presented for information purposes only. [orpha.net]

Diagnosis - Epidermodysplasia verruciformis Prognosis - Epidermodysplasia verruciformis Not supplied. Treatment - Epidermodysplasia verruciformis Resources - Epidermodysplasia verruciformis Not supplied. [checkorphan.org]

PROGNOSIS AND TREATMENT CHARACTERIZATION PROGNOSIS Squamous cell carcinoma develops in 30-50% of cases TREATMENT Treatment of epidermodysplasia verruciformis with a combination of acitretin and interferon alfa-2a Rana Anadolu, MD, etal J Am Acad Dermatol [thedoctorsdoctor.com]

Not only are they unsure of Taluli's prognosis, but they don't know if similar surgery and treatment would work on other severe cases of epidermodysplasia verruciformis. [npr.org]

We aim to decipher novel genetic etiologies of EV following hypothesis-free, genome-wide approaches, which may reveal new aspects of the molecular and cellular mechanisms underlying cutaneous immunity against EV-HPVs. [grantome.com]

/PATHOGENESIS Environmental Exposure • HPV infection is established as etiologic agent Only gold members can continue reading. [basicmedicalkey.com]

Epidermoid inclusion cysts are common lesions with unclear etiology. We sought to examine evidence for human papillomavirus (HPV) infection and ultraviolet light (UV) exposure as risk factors in the formation of epidermoid inclusion cysts. [ncbi.nlm.nih.gov]

Etiology EV can be caused by loss-of-function mutations in either of the 2 adjacent genes EVER1/TMC6 or EVER2/TMC8 (17q25.3) coding for membrane proteins that form a complex with the Zinc transporter protein ZnT-1 in the endoplasmic reticulum (ER) membrane [orpha.net]

The epidemiology, virology, and natural history of HPV infection are discussed separately. ● (See "Human papillomavirus infections: Epidemiology and disease associations" .) ● (See "Virology of human papillomavirus infections and the link to cancer" . [uptodate.com]

The epidemiological and clinical features of seven cases with EV that have been followed up for 5 years were included in the study. Seven cases consisted of four males and three females. All seven cases were working outdoors. [ncbi.nlm.nih.gov]

We describe a case of EV in a patient with LP and discuss the pathophysiology. [ncbi.nlm.nih.gov]

The pathophysiology of epidermodysplasia verruciformis is linked to defective cell-mediated immunity, with elucidation of mutations in EVER1 ( TMC6 ) and EVER2 ( TMC8 ) genes (band 17q25). [2, 7] Their gene products are integral membrane proteins localized [emedicine.com]

There is a genetic component in the etiology, but the inheritance pattern is uncertain at present.The pathophysiology of epidermodysplasia verruciformis (EV) is linked to defective cell-mediated immunity with elucidation of mutations in EVER1 and EVER2 [medigoo.com]

Although there is no standardized treatment for acquired EV, prevention and surveillance for transformation to squamous cell carcinoma are primary concerns. [ncbi.nlm.nih.gov]

This method has shown promising results in prevention of further carcinomas. [allhealthsite.com]

It has been shown that zinc is a necessary cofactor for many viral proteins, and that the activity of EVER1/EVER2 complex appears to restrict the access of viral proteins to cellular zinc stores, limiting their growth Prevention - Epidermodysplasia verruciformis [checkorphan.org]

1. Emsen IM, Kabalar ME. Epidermodysplasia verruciformis: An early and unusual presentation. Can J Plast Surg. 2010;18(1):21-24.
2. McDermott DH, Gammon B, Snijders PJ, et al. Autosomal dominant epidermodysplasia verruciformis lacking a known EVER1 or EVER2 mutation. Pediatr Dermatol. 2009;26(3):306-310.
3. Rogers HD, Macgregor JL, Nord KM, et al. Acquired epidermodysplasia verruciformis. J Am Acad Dermatol. 2009;60(2):315-320.
4. Gül U, Kiliç A, Gönül M, Cakmak SK, Bayis SS. Clinical aspects of epidermodysplasia verruciformis and review of the literature. Int J Dermatol. 2007;46(10):1069-1072.
5. Sá NB, Guerini MB, Barbato MT, Di Giunta G, Nunes DH. Epidermodysplasia verruciformis: clinical presentation with varied forms of lesions. An Bras Dermatol. 2011;86(4 Suppl 1):S57-60.
6. Segura S, Carrera C, Ferrando J, et al. Dermoscopy in epidermodysplasia verruciformis. Dermatol Surg. 2006;32(1):103-106.