Epidermodysplasia Verruciformis (Lewandowsky and Lutz's Dysplasia)

A woman in her twenties, with a non-consanguineous marriage, presented to the dermatology clinic with asymptomatic lesions on her face, neck, trunk, and extremities for the past 12 years. The general physical and systemic examination was unremarkable. Cutaneous examination revealed multiple hypopigmented to a few hyperpigmented, slightly scaly tinea versicolor-like macules distributed predominantly on the neck, upper portion of the back, and distal parts of the extremities (Figures 1-5). There were muultiple, slightly erythematous to violaceous flat-topped wart-like papules and plaques were discovered on the arms (Figures 1 and 2), with seborrheic keratosis-like lesions on the face (Figure 5). Baseline investigations, such as complete blood count (CBC), liver function test (LFT), kidney function test (KFT), and plasma glucose levels, were normal. Serologic tests conducted for human immunodeficiency virus (HIV)-1 and HIV-2, and hepatitis B and C were nonreactive. Skin lesion potassium hydroxide (KOH) examination from tinea versicolor-like lesions was negative for fungal elements. Skin biopsies were performed from tinea versicolor-like macules present on the upper portion of the back, flat wart-like plaque on the dorsum of the left hand, and hyperpigmented scaly plaque in the extensor area of the left leg. Histopathologic examination revealed parakeratosis, hyperkeratosis, and acanthosis with swollen keratinocytes, bluish-gray cytoplasm, and rounded nuclei with prominent nucleoli. No dysplastic changes/atypia or mitotic figures (Figures 6 and 7), plus occasional perinuclear halo (a vacuolated area that surrounds the nucleus), were observed. Following clinicopathologic correlation, the patient was diagnosed with epidermodysplasia verruciformis (EV, or Lewandowsky and Lutz's dysplasia).