Epidermodysplasia Verruciformis

A 23-year-old man complained of unsightly “flat warts” all over his chest. These lesions first appeared in early adolescence. The clinical suspicion of epidermodysplasia verruciformis was confirmed by a biopsy.

Epidermodysplasia verruciformis is a rare disease characterized by chronic, extensive human papillomavirus (HPV)–induced warts. Between 25% and 50% of cases are inherited; autosomal recessive pattern is the predominant mode, but X-linked inheritance has been reported as well.

The lesions can be reddish, scaling papules that resemble flat warts or may arise as scaling macules, which are similar in appearance to tinea versicolor eruptions.

Epidermodysplasia verruciformis needs to be considered in patients who have tinea versicolor that does not respond to treatment.

Drs Charles E. Crutchfield III and Humberto Gallego of St Paul, write that epidermodysplasia verruciformis warts caused by HPV-5 and HPV-8 often progress to squamous cell carcinoma. The skin cancer usually develops in the second decade of life, 2 to 20 years after the lesions first appear. Primarily, tumors develop on the sun-exposed areas of the body.

This patient requires frequent follow-up; biopsy and excision are performed as needed, and topical retinoids are used. To date, squamous cell carcinoma has not developed in this patient.