Inflammatory Linear Verrucous Research Articles

Possible indications for vitamin D3analogues in conditions other than psoriasis vulgaris

Vitamin D3 analogues interfere with various aspects of cutaneous inflammation, keratinization and epidermal proliferation, and are effective in chronic plaque psoriasis. Recently their clinical efficacy has been investigated in other skin disorders. So far, the vitamin D3 analogue calcipotriol has proved to be effective in pustular psoriasis, congenital ichthyosis, inflammatory linear verrucous epidermal naevus, Graver's disease and pityriasis rubra pilaris. Information on the effect of other vitamin D3 analogues in these conditions is limited.

The CHILD nevus: a distinct skin disorder.

The CHILD syndrome is characterized by an ichthyosiform and inflammatory nevus showing a strikingly unilateral arrangement. No particular name has so far been given to this nevus, which is why this skin disorder has been described under various inappropriate terms such as epidermal nevus, inflammatory linear verrucous epidermal nevus (ILVEN), unilateral ichthyosiform erythroderma, unilateral ichthyosis or verruciform xanthoma. In order to avoid such confusion and to make it easier for clinicians to recognize this skin disease, a new name should be given to this disorder, and the diagnostic criteria should be delineated. The term CHILD nevus is proposed and the distinctive clinical, histopathological and ultrastructural features of this disorder are described. A comprehensive clinical and genetic comparison shows that the CHILD nevus can be distinguished from all other types of epidermal nevi by characteristic features such as ptychotropism, waxy yellowish scaling, a unique lateralization pattern showing both diffuse and linear involvement and the presence of foamy histiocytes in the papillae ('verruciform xanthoma'). Contrasting with all other epithelial nevi, the CHILD nevus is an inherited X-linked dominant, male-lethal trait. This nevus represents a separate cutaneous entity. Future clinical research will probably show that the underlying gene defect often manifests itself as an isolated skin disorder. Such cases should no longer be confused with ILVEN. Recognition of this particular skin disorder is important for genetic counseling because a woman showing an isolated CHILD nevus has an increased risk of giving birth to a daughter suffering from a complex congenital disorder, the CHILD syndrome.

Inflammatory linear verrucous epidermal naevus with auto-immune thyroiditis: coexistence of two auto-immune epithelial inflammations?

The copper vapour laser has in theory qualities which make it interesting in the treatment of cutaneous vascular malformations. In order to study the clinical effect of the copper vapour laser and to compare its effect with the effect of the argon laser, we treated 38 patients with port-wine stain or facial telangiectasia with the copper vapour laser. Thirty-one patients were evaluated and of these 24 were improved or much improved. Nineteen patients had previously been treated with the argon laser, and in this group the copper vapour laser had better effect than the argon laser in 8 patients and equal effect in 9 patients. In 7 patients side-effects like scarring or hyperpigmentation were noted after treatment with copper vapour laser.

Phalangeal osteomyelitis due to nail biting.

We report a patient with an inflammatory linear verrucous epidermal naevus (ILVEN) coexisting with an auto-immune lymphocytic thyroiditis. The occurrence of two epithelial inflammatory processes could be linked and raises the question of auto-immune involvement in the inflammatory part of ILVEN. Moreover, expression of a membrane antigen, OKM5, usually assigned to antigen-presenting cells, especially macrophages, has been demonstrated on keratinocytes in some dermatological diseases including ILVEN. These data suggest that keratinocytes in ILVEN could present some antigens and perhaps auto-antigens modified by the hamartomatous process, leading to an (auto-immune?) inflammatory reaction.

Management of linear verrucous epidermal nevus with topical 5-fluorouracil and tretinoin

Linear verrucous epidermal nevus (LYEN) is an uncommon cutaneous hamartoma first described by von Baerensprung in 18631 and later reported by Unna in 1896.2 It has since been given a variety of names, including epidermal linear nevus, ichthyosis hystrix, ichthyosis linearis neuropathica, nevusunius lateris, and inflammatory linear verrucous epidermal nevus.I? Three types of LYEN exist and include the localized, systemic, and the inflammatory linear verrucous varieties. Surgical and nonsurgical management of these nevi has proved difficult, even in localized cases. We report marked improvement of a large LYEN with a combination of topical tretinoin (Retin-A) 0.1% cream and 5% 5-fluorouracil (5-FU) (Efudex) cream under occlusion.

Immunohistochemical features in inflammatory linear verrucous epidermal nevi suggest a distinctive pattern of clonal dysregulation of growth

We studied biopsy material from four patients with inflammatory linear verrucous epidermal nevi (ILVEN) that had a psoriasiform appearance histologically and seven cases of linear epidermal nevi (LEN). Of the seven LEN, five showed hyperkeratosis, papillomatosis, and varying degrees of acanthosis; two had features of epidermolytic hyperkeratosis. Because these lesions have distinctive histologic patterns, we wanted to determine whether we could also demonstrate a distinctive pattern of immunohistochemical markers. On all 11 cases we performed immunohistochemical stains for PCNA, factor XIIIa, MAC-387, UCHL-1, and OPD-4. In addition, on one case of ILVEN we performed ICAM-1, ELAM-1, and HLA-DR stains. The pattern of staining of PCNA, factor XIIIa, MAC-387, UCHL-1, and OPD-4 was distinctly different in ILVEN and LEN. Staining for ICAM-1 was present on keratinocytes, and ELAM-1 was present on endothelial cells in two cases of ILVEN. HLA-DR in these same two cases of ILVEN stained mainly dendritic cells in the epidermis. The different pattern of staining of PCNA, factor XIIIa, MAC-387, UCHL-1, and OPD-4 in LEN and ILVEN indicates a different mechanism of growth dysregulation. Stains for ICAM-1, ELAM-1, and HLA-DR in ILVEN suggest that an inability to down-regulate the inflammatory infiltrate may be important in the growth dysregulation in ILVEN. In addition, the onset of ILVEN at the time of HIV-1 infection in one patient suggests that HIV-1 infection may be one of many factors that initiates ILVEN in a susceptible person.

Inflammatory linear verrucous epidermal naevus (ILVEN) versus linear psoriasis. A clinical, histological and immunohistochemical study.

Inflammatory Linear Verrucous Epidermal Nevus (ILVEN) has been suggested to be a separate disease entity. However, the distinction from linear psoriasis has been discussed in the literature over recent decades. The aim of the present study was to investigate, in addition to the clinical and histological criteria, the immunohistochemical aspects of inflammation, epidermal proliferation and keratinization. From a clinical and histological point of view, ILVEN and psoriasis, according to the established criteria, have been proved to overlap. The immunohistochemical study suggests that the following procedures have an additional diagnostic impact: assessment of elastase-positive cells, assessment of keratin 16 and of keratin 10.

Treatment of Inflammatory Linear Verrucous Epidermal Nevus

Inflammatory linear verrucous epidermal nevus (ILVEN) is a rare and chronic skin disorder, which may trouble the patient considerably. The condition is generally believed to be resistant to therapy, although some authors have reported success with several treatments. including dithranol and etretinate. The present case, a classical presentation of ILVEN, again illustrates the refractoriness to various treatments, including an experimental treatment with topical 13-cis-retinoic acid. A review of the literature on therapeutic possibilities of ILVEN is presented. Based on our own observations and literature data, it is attractive to hypothesize that a positive result with treatments such as dithranol and retinoids should be interpreted as an antipsoriatic effect in ILVEN with superimposed psoriasis.

Ptychotropism as a cutaneous feature of the CHILD syndrome

The hallmark of the CHILD syndrome is a unilateral ichthyosiform nevus that displays a pronounced affinity for the body folds. For this phenomenon the term ptychotropism is proposed. The expression is composed from the Greek words ptyché (fold) and tropé (a turning). It is concluded that the cutaneous lesions of the CHILD nevus are determined by two factors, lyonization and ptychotropism. The phenomenon of ptychotropism constitutes an additional argument to distinguish the CHILD nevus from the inflammatory linear verrucous epidermal nevus because the latter is not ptychotropic.

Lichenoid epidermal nevus: “Linear lichen planus”

A 3-year-old girl had an eruption that showed clinical and histologic evidence of both a verrucous epidermal nevus and a lichenoid tissue reaction. Linear plaques had been present on her right lower limb for 2 years. Microscopic features included hyperkeratosis, papillomatosis, acanthosis, a bandlike lymphohistiocytic infiltrate that obscured the dermoepidermal junction, Civatte bodies, andmelanophages. Lichenoid epidermal nevus is a new variant of linear verrucous epidermal nevus. At least some of the cases previously diagnosed as linear lichen planus probably represent lichenoid epidermal nevus. There is a parallel between lichenoid epidermal nevus and the entity described as inflammatory linear verrucous epidermal nevus, which frequently was misinterpreted as linear psoriasis before it was recognized as a linear verrucous epidermal nevus with psoriasiform features.

Inflammatory linear verrucous epidermal nevus: report of seven new cases and review of the literature.

In seven patients with inflammatory linear verrucous epithelial nevus (ILVEN) examined, the condition demonstrated the typical clinical and histologic picture. Based on this experience, we suggest revised criteria for the disease. Dermatologists and pediatricians aware of ILVEN can easily differentiate it from similar lesions and thus be able to suggest effective therapy.

Inflammatory Linear Verrucous Epidermal Nevus

Inflammatory linear verrucous epidermal nevus (ILVEN) may be difficult to differentiate clinically from psoriasis. We report four cases of ILVEN that confirm the observation that the analysis of epidermal proteins by sodium lauryl sulfate-polyacrylamide gel electrophoresis (SLS-PAGE) discloses a pattern different from that seen in psoriasis. We have also found, however, that the SLS-PAGE epidermal protein pattern is not identical in each case of ILVEN.

Clinico-histopathological study of epidermal naevi.

SummaryThe clinical and histopathological features of epidermal naevi from 75 patients were reviewed. In approximately two‐thirds of the patients, these lesions were not present at birth. Five classical clinical varieties and ten histopathological patterns were observed. It was only possible to determine the types of histopathological patterns by the examination of the clinical features alone in the cases of linear porokeratosis and linear naevus comedonicus. A further clinical type of inflammatory linear verrucous epidermal naevus was revealed in this study. This consisted of asymptomatic short linear brownish plaques in which the lesions did not resemble the classical itching linear erythematous plaques.

Differential Diagnosis in Dermatopathology-Reply

In Reply.— Dr Ackerman is right in that there was somehow an error in the comparison. However, my main point still stands that dermatologists seek pathologic confirmation in most instances because of difficult problems in clinical differentiation. Porokeratosis would rarely be confused with inflammatory linear verrucous epidermal nevus, and, in most instances, seborrheic keratosis would rarely be confused with that of eccrine poroma. Therefore, the biopsy arriving at the pathologist's desk would rarely consider both in the differential, even though they might appear similar histologically. It is in those rare instances where the clinical appearance and the histologicappearance are similar, that the skills of one such as Dr Ackerman are really needed, since the slides are often sent to him for a second opinion!

Inflammatory Linear Verrucous Epidermal Naevus

A case of inflammatory linear verrucous epidermal naevus is described. Unusual features were the widespread and bilateral distribution, nail involvement, and the abundance of capillaries in the dermis.

Differential Diagnosis in Dermatopathology.

To the Editor.— In his recent review of our book entitled Differential Diagnosis in Dermatopathology , Larry E. Millikan, MD, wrote that some entries appear of dubious value because of the minimal likelihood of difficulty in clinical differentiation, eg, porokeratosis v eccrine poroma. I respond to correct an error by Dr Millikan. We did not contrast porokeratosis with eccrine poroma, but with inflammatory linear verrucous epidermal nevus. Differentiating the latter two conditions histologically is a challenge to pathologists, as are each of the 45 sets of diseases that we contrasted.

Analysis of Epidermal Fibrous Proteins in Inflammatory Linear Verrucous Epidermal Nevus

A baby had inflammatory linear verrucous epidermal nevus (ILVEN). Scale from the lesion was analyzed by sodium lauryl sulfate polyacrylamide gel electrophoresis. It showed a pattern different from psoriatic scale. This procedure was useful in distinguishing the lesion (or ILVEN) from psoriasis, the diagnosis that had been made earlier.

Inflammatory Linear Verrucous Epidermal Nevus

A female infant was noted at birth to have severe skeletal anomalies of the right upper and lowere extremities. These anomalies were associated with an inflammatory linear verrucous epidermal nevus (ILVEN). Like the noninflammatory type of epidermal nevus, ILVEN may be a component of the epidermal nevus syndrome.