Hypertrichotic Verrucous Pigmented Plaque Over Extremities-A Clue Toward Early Verrucous Venous Malformation

Verrucous venous malformation (VVM), also known as verrucous hemangioma, is a congenital vascular anomaly characterized by malformed dermal venule-like channels and hyperkeratotic skin. This study presents 5 cases of VVM that manifested as hyperpigmented, slightly verrucous plaques with hypertrichosis, where the diagnosis was not initially suspected. The average age of the patients was 9 years, with lesions predominantly located on the lower extremities. Histopathological examination confirmed VVM through findings of hyperkeratosis, acanthosis, and dilated vascular channels in the dermis. The differential diagnoses included dermatofibroma, mastocytoma, and eccrine angiomatous hamartoma. Dermoscopic features revealed bluish red lagoons and blue-white veil patterns, assisting in distinguishing VVM from other vascular lesions. Notably, the presence of hypertrichosis and hyperpigmentation in these patients has not been previously documented and may serve as early indicators of VVM. The study highlights the need for awareness of these clinical features to avoid misdiagnosis because VVM can often be confused with other dermatological conditions.