IJD
Indian Journal of Dermatology
  Publication of IADVL, WB
  Official organ of AADV
Indexed with Science Citation Index (E) , Web of Science and PubMed
 
Users online: 416  
Home About  Editorial Board  Current Issue Archives Online Early Coming Soon Guidelines Subscriptions  e-Alerts    Login  
    Small font sizeDefault font sizeIncrease font size Print this page Email this page


 
Table of Contents 
E-IJD CORRESPONDENCE
Year : 2015  |  Volume : 60  |  Issue : 3  |  Page : 323
A case of inflammatory linear verrucous epidermal nevus on the upper eyelid


Department of Dermatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii cho, Kawaramachi Hirokoji, Kamigyo ku, Kyoto 602 8566, Japan

Date of Web Publication6-May-2015

Correspondence Address:
Noriaki Nakai
Department of Dermatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii cho, Kawaramachi Hirokoji, Kamigyo ku, Kyoto 602 8566
Japan
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.156462

Rights and Permissions



How to cite this article:
Nakai N, Ohshita A, Katoh N. A case of inflammatory linear verrucous epidermal nevus on the upper eyelid. Indian J Dermatol 2015;60:323

How to cite this URL:
Nakai N, Ohshita A, Katoh N. A case of inflammatory linear verrucous epidermal nevus on the upper eyelid. Indian J Dermatol [serial online] 2015 [cited 2021 Aug 3];60:323. Available from: https://www.e-ijd.org/text.asp?2015/60/3/323/156462


Sir,

Inflammatory linear verrucous epidermal nevus (ILVEN) presents as a persistent, linear, intensely pruritic lesion composed of erythematous, slightly verrucous, scaly papules arranged in one or several lines. ILVEN usually appears on a lower extremity in early childhood. [1] Here, we report the first case of ILVEN on the upper eyelid.

A 19-year-old Japanese woman was referred to our department for diagnosis of a pruritic lesion on the right upper eyelid that had been present for 12 years without significant extension. She had been treated with cryotherapy and oral administration of the Chinese traditional medicine at other hospitals, but the treatments were ineffective. In our initial physical examination, erythematous and verrucous papules were seen on the right upper eyelid. The lesions were located at right upper eyelid extending from infero-medial to supero-lateral regions [Figure 1]a. She had no history of internal diseases or other skin diseases. A 3-mm punch biopsy specimen was taken from one of the papules. The histopathology showed hyperkeratosis with foci of parakeratosis, acanthosis, elongation, and thickening of the rete ridges, and moderate perivascular inflammatory infiltrate. A sharply demarcated alteration of orthokeratosis and parakeratosis in the cornified layer was observed [Figure 1]b. The parakeratotic areas were slightly raised and lacked a granular layer with slight spongiosis [Figure 1]c. The orthokeratotic areas showed a preserved granular layer [Figure 1]d. The superficial dermis showed moderate perivascular inflammatory infiltrate of lymphocytes and histiocytes [Figure 1]c and d]. There were no intranuclear inclusion bodies in the granular layer. From these results, we diagnosed this case as ILVEN. CO 2 laser therapy as well as conventional topical corticosteroid therapy was recommended for treatment of the ILVEN, but she selected observation of the clinical course.
Figure 1: Clinical photograph (a) and histopathological study (b-d). (a) Erythematous and verrucous papules were seen on the right upper eyelid. The lesions were located at the right upper eyelid extending from infero-medial to supero-lateral regions. (b) The histopathology showed hyperkeratosis with foci of parakeratosis, acanthosis, elongation, and thickening of the rete ridges, and moderate perivascular inflammatory infiltrate. A sharply demarcated alteration of orthokeratosis and parakeratosis in the cornified layer was observed (hematoxylin-eosin [H and E] staining, original magnification ×40). (c) The parakeratotic areas were slightly raised and lacked a granular layer. Slight spongiosis was present. The superficial dermis showed moderate perivascular inflammatory infiltrate of lymphocytes and histiocytes (H and E, ×100). (d) The orthokeratotic areas showed a preserved granular layer. The superficial dermis showed moderate perivascular inflammatory infiltrate of lymphocytes and histiocytes (H and E, ×100)

Click here to view


ILVEN was first reported by Altman and Mehregan in 1971. [2] They described the clinical and histopathologic characteristics: (1) early age of onset, (2) 4:1 predominance in females, (3) frequent involvement of the left lower extremity, (4) pruritus, (5) distinctive inflammatory and psoriasiform histologic appearance, and (6) persistent lesions showing marked refractoriness to treatment. Lee and Rogers [3] reviewed 23 cases of ILVEN. They concluded that ILVEN might occur in equal sex distribution and the lesions were seen in the lower half of the body in almost all patients. In our case, the eruption was located at an unusual site and showed unusual clinical findings. The differential of linear verurccous papules included epidermal nevus and koebnerized verruca. However, based on the histopathological findings, a diagnosis of ILVEN was made. To the best of our knowledge, this is the first report of ILVEN occurring on the upper eyelid. Recently, the effectiveness of laser therapy, surgical excision and skin grafting, and trichloroacetic acid peeling for treatment of ILVEN has been reported. [4],[5]

Therefore, observation of the clinical course, examination of the medical history, and skin biopsy are crucial in the diagnosis of ILVEN, especially in cases with an atypical presentation. This case illustrates the importance of medical practitioners being aware of the fact that ILVEN may occur on areas of the face.

 
   References Top

1.
Mobini N, Toussaint S, Kamino H. Noninfectious erythematous, papular, and squamous diseases. In: Elder DE, editor. Lever's Histopathology of the Skin. 10 th edn. Philadelphia, PA: Lippincott Williams and Wilkins; 2009. p. 194-5.  Back to cited text no. 1
    
2.
Altman J, Mehregan AH. Inflammatory linear verrucose epidermal nevus. Arch Dermatol 1971;104:385-9.  Back to cited text no. 2
    
3.
Lee SH, Rogers M. Inflammatory linear verrucous epidermal naevi: A review of 23 cases. Australas J Dermatol 2001;42:252-6.  Back to cited text no. 3
    
4.
Behera B, Devi B, Nayak BB, Sahu B, Singh B, Puhan MR. Giant inflammatory linear verrucous epidermal nevus: Successfully treated with full thickness excision and skin grafting. Indian J Dermatol 2013;58:461-3.  Back to cited text no. 4
[PUBMED]  Medknow Journal  
5.
Toyozawa S, Yamamoto Y, Kaminaka C, Kishioka A, Yonei N, Furukawa F. Successful treatment with trichloroacetic acid peeling for inflammatory linear verrucous epidermal nevus. J Dermatol 2010;37:384-6.  Back to cited text no. 5
    


    Figures

  [Figure 1]



 

Top
Print this article  Email this article
 
 
  Search
 
  
    Similar in PUBMED
    Article in PDF (737 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  


    References
    Article Figures

 Article Access Statistics
    Viewed2275    
    Printed17    
    Emailed0    
    PDF Downloaded45    
    Comments [Add]    

Recommend this journal