Abdominal Elephantiasis Nostras Verrucosa: An Underrecognized Disorder

Area of Science:

• Dermatology
• Vascular Medicine

Background:

• Morbid obesity presents significant challenges in personal hygiene and skin care.
• Chronic intertrigo and superinfections are common complications in individuals with excessive skinfolds.
• Lymphedema and venous stasis can exacerbate skin conditions in obese patients.

Observation:

• A 60-year-old African American man with morbid obesity (>550 lb) presented with recurrent abdominal skin irritation and cellulitis.
• Physical examination revealed significant skinfolding, hyperpigmentation, cobblestone changes, and induration consistent with chronic elephantiasis nostras verrucosa (ENV) and lipodermatosclerosis (LDS).
• The patient had a history of multiple hospitalizations for cellulitis over 8 years, linked to hygiene difficulties and potential superinfections.

Findings:

• The patient's presentation is characteristic of advanced chronic elephantiasis nostras verrucosa (ENV) and lipodermatosclerosis (LDS).
• Findings suggest a complex interplay of morbid obesity, impaired lymphatic and venous drainage, and secondary bacterial or fungal infections.
• The condition has led to significant morbidity, including recurrent cellulitis and limitations in daily functioning.

Implications:

• Management of ENV and LDS in morbidly obese patients necessitates a multidisciplinary approach, focusing on weight reduction and infection control.
• Early recognition and intervention are crucial to prevent disease progression and reduce hospitalization rates.
• Further research into optimal treatment strategies for these debilitating skin conditions in the context of extreme obesity is warranted.