Linear epidermolytic acanthoma or adult-onset verrucous epidermal nevus?

M Ramam

 Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi - 110 029, India

Correspondence Address:
M Ramam
Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi - 110 029
India

Sir,

Thomas et al. reported a 50-year-old woman who had unilateral, linearly arranged verrucous papules and plaques on the labia majora and on the adjacent perineum and thigh. Biopsy revealed features of epidermolytic hyperkeratosis. A diagnosis of linear epidermolytic acanthoma was made. ^[1]

Several features of the case closely match the findings of verrucous epidermal nevus of the epidermolytic hyperkeratotic type: unilaterality, linear/Blashckoid arrangement of papules and the variable degree of verrucosity in the papules and plaques as seen in the clinical image. On the other hand, as indicated by the authors, epidermolytic acanthomas are usually solitary lesions and, even when multiple, do not have a unilateral, Blaschkoid distribution. Thomas et al. excluded the diagnosis of verrucous epidermal nevus because of onset of lesions in adulthood and gradual progression over the next several years. However, there are reports of adult-onset epidermal nevus in the literature. Adams and Mutasim described a woman who developed a progressive epidermal nevus on the face at the age of 55 years. They also reviewed five other publications reporting epidermal nevi that began in adulthood. ^[2] Two other reports have been published since then. ^[3],[4]

Taken together, the clinical and histopathological features appear to be a better fit for the diagnosis of adult-onset verrucous epidermal nevus of the epidermolytic hyperkeratotic type than for linear epidermolytic acanthoma.

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