Linear Verrucous Epidermal Nevus

A 7-year-old boy with a history of atopic dermatitis presented with an intensely pruritic linear rash on his upper extremity. His mother reports that the rash has been “growing” despite use of topical corticosteroid creams.

Physical examination revealed a unilateral, linear, erythematous collection of scaly papules that coalesced into plaques. These extended from the posterior neck distally to the boy's elbow, forearm, wrist, dorsal hand, and fingers.

Darren K. Mollick, MD, Brigitte A. Holder, MD, and Yelva Lynfield, MD, of the department of dermatology at the State University of New York Downstate Medical Center in Brooklyn write that this lesion is an inflammatory linear verrucous epidermal nevus. It is intensely pruritic, unilateral, and linear, with grouped, scaly, rosy-colored papules. This uncommon skin condition usually manifests in young children: 50% of cases develop in those who are younger than 6 months, and 75% occur in children younger than 5 years. The diagnosis is confirmed histologically.

This condition is resistant to therapy. Options include topical or intralesional corticosteroids, trichloracetic acid, cryotherapy, podophyllin, topical 5-fluorouracil with retinoic acid, tar preparations, calcipotriol, laser, or excision.

FOR MORE INFORMATION:

• Gatti S, Carrozzo AM, Orlandi A, et al. Treatment of inflammatory linear verrucous epidermal naevus with calcipotriol. Br J Dermatol. 1995;132:837-839.
• Mitsuhashi Y, Katagiri Y, Kondo S. Treatment of inflammatory linear verrucous epidermal naevus with topical vitamin D3. Br J Dermatol. 1997;134-135.

• Morag C, Metzker A. Inflammatory linear verrucous epidermal nevus: report of seven new cases and review of the literature. Pediatr Dermatol. 1985;3:15-18.