|LETTER TO EDITOR
|Year : 2015 | Volume
| Issue : 2 | Page : 110-111
Verrucous epidermal nevus on female genitalia: A rare presentation
Tejinder Kaur1, Amarjit Singh Kataria2, Anisha Sethi3
1 Department of Dermatology, Venereology and Leprology, Government Medical College, Amritsar, Punjab, India
2 Department of Pathology, Government Medical College, Amritsar, Punjab, India
3 Department of Dermatology, Venereology and Leprology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
|Date of Web Publication||9-Apr-2015|
C 12, Medical College Campus, Amritsar, Punjab
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kaur T, Kataria AS, Sethi A. Verrucous epidermal nevus on female genitalia: A rare presentation. Indian J Paediatr Dermatol 2015;16:110-1
|How to cite this URL:|
Kaur T, Kataria AS, Sethi A. Verrucous epidermal nevus on female genitalia: A rare presentation. Indian J Paediatr Dermatol [serial online] 2015 [cited 2020 Jan 22];16:110-1. Available from: http://www.ijpd.in/text.asp?2015/16/2/110/152122
Verrucous epidermal nevi (VEN) typically occur on trunk or extremities along the Lines of Blaschko More Details but may occur on face and neck. , There are only a few reports of VEN occurring on genitalia in literature. Herein we report a case of VEN over female genitalia.
A 7-year-old girl presented with the chief complaint of asymptomatic, irregular linear growth over the medial side of left thigh extending upward toward the labia majora. The lesion was present since birth and gradually increased in size with raised and irregular surface. Birth history and milestones were normal. There was no significant family history, no history of sexual abuse and no history of viral warts in the parents. Cutaneous examination revealed brown colored, hyperkeratotic, papular lesions coalescing to form a plaque on the anteromedial aspect of left thigh extending up to the labia majora on the same side [Figure 1]. Detailed muco-cutaneous and systemic examination did not reveal any other abnormality. Keeping in mind the onset and progression of the lesions, provisional diagnosis of VEN was kept. The diagnosis was confirmed on histopathology that showed hyperkeratosis, papillomatosis and degeneration of the granular layer [Figure 2].
|Figure 1: Verrucous plaque on the left side of the thigh extending over to labira majora|
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|Figure 2: H and E section showing hyperkeratosis, papillomatosis and degeneration of the granular layer (×10)|
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Epidermal nevi are cutaneous hamartomas that develop from embryonic ectoderm.  They can occur singly or as a part of epidermal nevus syndrome. Histopathology shows the hyperkeratosis, papillomatosis and acanthosis with elongation of rete ridges.  Differential diagnosis includes genital warts, sexual abuse, lichen nitidus, linear lichen planus. All of these are acquired conditions.
For epidermal nevi, patients usually seek advice for cosmetic reasons. Various treatment options are available, but none is ideal. Topical therapies that have been tried include keratolytics like combination of retinoic acid and 5-fluorouracil, salicylic acid, calcipotriol, dithranol, chemical peels, occlusive topical steroids and podophyllin. These may improve the irregular surface but have a high rate of recurrence.  Other modalities such as cryosurgery, dermabrasion and electrocautry have higher rate of recurrence and scarring.  Ablative lasers such CO 2 , Erbium YAG and Nd: YAG have been used with better cosmetic outcome. 
The course of the disease is usually benign; however, emotional, sexual and functional aspects should be considered, if lesions are present on the genitalia. Recently, malignant changes in VEN have also been reported.  Therefore, biopsy is recommended in doubtful cases. The treatment of choice should be targeted at good cosmetic results in such presentations. Another significant observation in our case was the involvement of the left side that is consistent with the previous reports.  This predilection for the left side needs to be further explored. Yet another finding in our case was that it was not pruritic as majority of the previous case reports are associated with pruritus giving clue that it is not an inflammatory variety. 
To conclude, the case is being reported for its rare presentation.
| References|| |
Atherton DJ. Naevi and other developmental defects. In: Champion RH, Burton JL, Burns DA, Breathnach SM, editors. Textbook of Dermatology. 6 th
ed. Oxford: Blackwell Science; 1998. p. 519-616.
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.
Kumar CA, Yeluri G, Raghav N. Inflammatory linear verrucous epidermal nevus syndrome with its polymorphic presentation - A rare case report. Contemp Clin Dent 2012;3:119-22.
Pierson D, Bandel C, Ehrig T, Cockerell CJ. Benign epidermal tumors and proliferations. In: Bolognia JL, Jorizzo JL, Rapini RP, editors. 1 st
ed. Dermatology. Philadelphia: Mosby; 2003. p. 1697-720.
Attia A, Elbasiouny MS. Treatment of verrucous epidermal nevus using long pulsed Nd: YAG laser. Egypt Dermatol Online J 2010;6:2.
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.
Nag F, Ghosh A, Surana TV, Biswas S, Gangopadhyay A, Chatterjee G. Inflammatory linear verrucous epidermal nevus in perineum and vulva: A report of two rare cases. Indian J Dermatol 2013;58:158.
[Figure 1], [Figure 2]