Indian Journal of Dermatology
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Year : 2005  |  Volume : 50  |  Issue : 3  |  Page : 168-169
Zosteriform verrucous epidermal nevus

Department of Dermatology, Christian Medical College & Hospital, Ludhiana -141008 (Punjab), India

Correspondence Address:
Emy Aby Thomas
Department of Dermatology, Christian Medical College & Hospital, Ludhiana -141008 (Punjab)
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How to cite this article:
Thomas EA, Singla M, Shekhawat SS. Zosteriform verrucous epidermal nevus. Indian J Dermatol 2005;50:168-9

How to cite this URL:
Thomas EA, Singla M, Shekhawat SS. Zosteriform verrucous epidermal nevus. Indian J Dermatol [serial online] 2005 [cited 2022 May 18];50:168-9. Available from:

Verrucous epidermal nevus is a common type of keratinocyte hamartoma present at birth or occurring later in life. They occur about one in every thousand live births. It is seen at any site but is less common on the head and neck. Epidermal verrucous nevus is seen as vertical, linear or s-shaped lesion and does not normally cross midline.

   Case report Top

A 7-year-old girl born of a non-consanguinous marriage with multiple asymptomatic lesions on the head and neck, which had been present since early childhood. Besides, she had noticed similar lesion over the left ear lobe. There was no history of delayed developmental milestones or seizure disorders. The family history was negative as regards to similar lesions. Local examination revealed multiple linear brownish- black verrucous lesions over the front of the neck extending to the sides and posteriorly on the same side in a zosteriform pattern not crossing the midline [Figure - 1]. The lesions were also present on the left ear lobe, posterior auricular and occipital area on the same side [Figure - 2].

The left earlobe was 1cm bigger in size compared to the right. Hairs on the rest of the scalp and body were normal. There were no signs suggestive of angiomatous component in the nevus. Nails and mucous membranes were normal. Other physical, otolaryngological, neurological, bony and psychiatric examinations were normal. Routine blood and urine investigations were within normal limit. Histological examination of nevus revealed marked acanthosis, hyperkeratosis and papillomatosis of stratified squamous epithelium. Based on clinical and histological evidence, a diagnosis of verrucous epidermal nevus was made.

Epidermal nevi are hamartomatous lesions arising from embryonic ectoderm. Blaschko[1] documented that linear streaks and swirls adopted by these nevi may be due to somatic mutation, each lesion comprising the progeny of a single mutant keratinocyte. Widespread multiple epidermal nevi may reflect genetic or chromosomal mosaicism.[2] Blaschko[1] has documented characteristic linear, zosteriform, unilateral or systematized patterns with streaks and swirls. In some cases, most commonly when there are multiple lesions, there may be associated defects in other tissues, particularly the skeleton and the CNS, here the term 'epidermal nevus syndrome' is often applied.[3] Verrucous epidermal nevus has been reported in association with megalopinna[4] and wooly hair nevi[5].

In our patient multiple verrucous epidermal nevi were seen in a zosteriform pattern with involvement of ear lobe, which is an uncommon presentation. Our patient had multiple lesions but there was no associated systemic involvement. However, verrucous epidermal nevus involves head and neck area occasionally, ear lobe involvement is extremely rare.

   References Top

1.Jakson R. The lines of Blaschko: a review and reconsideration. Br J Dermatol 1976; 95: 349-59.  Back to cited text no. 1    
2.Happle R. Genetische interpretation Streifeformiger hautanumalien. Hautarzt 1978; 29: 357-63.  Back to cited text no. 2    
3.Solomon LM, Fretzin DF, Dewald RL. The epidermal naevus syndrome. Arch Dermatol 1968; 97: 273-85.  Back to cited text no. 3    
4.Mahakrishnan A. Megalopinna in naevus unius lateris: case report. Acta Derm Venereol 1981; 61: 365-7.  Back to cited text no. 4    
5.Wright S, Leomonine WR, Leigh IM. Wooly hair naevi with systematized linear epidermal naevus. Clin Exp Dermatol 1986; 11: 179-82.  Back to cited text no. 5    


[Figure - 1], [Figure - 2]


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