Facial verrucous epidermal nevus with pruritus: Successfully treated with photodynamic therapy

Verrucous epidermal nevus (VEN) is uncommon and is typically present at birth. The disorder is essentially cosmetic and is found more often in females which features were brown and skin-colored verrucous papules or plaques distributed linearly along Blaschko's lines. VEN on the face often adversely affect the patient's self-esteem. While complete excision of the lesion is curative, it may leave disfiguring scars. The treatment of VEN on the face is challenging. We report a case of 28-year-old woman who presented with a wart-like lesion on the left side of her face which was accompanied by pruritus. Dermoscopy and histopathological examination were performed and the patient was diagnosed with VEN. She was treated with the carbon dioxide(CO2) laser and aminolevulinate photodynamic therapy (ALA-PDT). The carbon dioxide laser was applied to remove the hypertrophic lesion and enable the transdermal absorption of aminolevulinic acid. The first step was the topical application of a cream with 20 % ALA to the lesion, after which the area was sealed for three hours to block light before PDT treatment. Subsequent PDT treatment enhanced healing and reduced potential scarring. After 4 sessions of ALA-PDT, only slight elevation of the skin at the tumor site was observed, and the lesion could be concealed with makeup, thereby achieving a superior cosmetic effect. The patient experienced a significant reduction in psychological stress with marked alleviation of the pruritis. Therefore, we consider that ALA-PDT combined with CO2 laser is both safe and effective for treating facial verrucous epidermal nevus.