Review
Acquired epidermodysplasia verruciformis: clinical presentation and treatment update
Stephen Moore,
Peter Rady MD, PhD,
Stephen Tyring MD, PhD, MBA,
Stephen Moore
Department of Dermatology, McGovern Medical School at UTHealth, Houston, Texas, USA
Rice University, Houston, Texas, USA
Search for more papers by this authorPeter Rady MD, PhD
Department of Dermatology, McGovern Medical School at UTHealth, Houston, Texas, USA
Search for more papers by this authorCorresponding Author
Stephen Tyring MD, PhD, MBA
Department of Dermatology, McGovern Medical School at UTHealth, Houston, Texas, USA
Correspondence
Stephen K. Tyring, MD, PhD, MBA
Department of Dermatology
McGovern Medical School at UTHealth
Houston, TX
USA
E-mail: [email protected]
Search for more papers by this authorStephen Moore,
Peter Rady MD, PhD,
Stephen Tyring MD, PhD, MBA,
Stephen Moore
Department of Dermatology, McGovern Medical School at UTHealth, Houston, Texas, USA
Rice University, Houston, Texas, USA
Search for more papers by this authorPeter Rady MD, PhD
Department of Dermatology, McGovern Medical School at UTHealth, Houston, Texas, USA
Search for more papers by this authorCorresponding Author
Stephen Tyring MD, PhD, MBA
Department of Dermatology, McGovern Medical School at UTHealth, Houston, Texas, USA
Correspondence
Stephen K. Tyring, MD, PhD, MBA
Department of Dermatology
McGovern Medical School at UTHealth
Houston, TX
USA
E-mail: [email protected]
Search for more papers by this authorConflict of interest: None.
Funding source: None.
Abstract
Acquired epidermodysplasia verruciformis (AEV) is a form of epidermodysplasia verruciformis (EV) that is most commonly found in immunocompromised or immunosuppressed patients. EV is commonly associated with human papillomavirus (HPV), which is often found in EV and AEV lesions. Clinical presentation of AEV in patients with organ transplantation, HIV+, congenital HIV+, hematological diseases, and other iatrogenic immunosuppression are reviewed. Treatment options include topical cidofovir, topical retinoids, topical imiquimod, topical glycolic acid, HPV 9-valent vaccine, acitretin, improving cellular immunity, and changing transplant medication to mycophenolate mofetil.
References
- 1Huang S, Wu JH, Lewis DJ, et al. A novel approach to the classification of epidermodysplasia verruciformis. Int J Dermatol 2018; 57: 1344–1350.
- 2Myers DJ, Fillman EP Epidermodysplasia verruciformis. In StatPearls [Internet]. StatPearls Publishing; 2019.
- 3Prose NS, von Knebel-Doeberitz C, Miller S, et al. Widespread flat warts associated with human papillomavirus type 5: a cutaneous manifestation of human immunodeficiency virus infection. J Am Acad Dermatol 1990; 23(5 Pt 2): 978–981.
- 4Rogers HD, MacGregor JL, Nord KM, et al. Acquired epidermodysplasia verruciformis. J Am Acad Dermatol 2009; 60: 315–320.
- 5da Cruz Silva LL, de Oliveira WRP, Sotto MN. Epidermodysplasia verruciformis: revision of a model of carcinogenic disease. Surg Exp Pathol 2019; 2: 20.
10.1186/s42047-019-0046-7 Google Scholar
- 6Barro TF, Traoré A, Goumbri LO, et al. Epidermodysplasia verruciformis: clinicaland epidemiological features of 45 cases in the Department of Dermatology at the University Hospital Center of Yalgado Ouedraogo, Ouagadougou. Dakar Med 2007; 52: 90–94.
- 7Gómez-Bernal S, Rodríguez-Pazos L, Pereiro-Ferreirós MM, et al. Acquired epidermodysplasia verruciformis in a renal transplant recipient. Actas Dermo-Sifiliográficas 2011; 102(2): 159–161.
- 8Vicente A, Pau-Charles I, González-Enseñat MA, et al. High-risk alpha-human papillomavirus types: detection in HIV-infected children with acquired epidermodysplasia verruciformis. J Am Acad Dermatol 2013; 68: 343–345.
- 9Morrison C, Eliezri Y, Magro C, et al. The histologic spectrum of epidermodysplasia verruciformis in transplant and AIDS patients. J Cutan Pathol 2002; 29: 480–489.
- 10Van Doorslaer K, Li Z, Xirasagar S, et al. The Papillomavirus Episteme: a major update to the papillomavirus sequence database. Nucleic Acids Res 2017; 45(D1): D499–D506.
- 11Mendes AD, Bittencourt MdJS, Moure ERD, et al. Acquired epidermodysplasia verruciformis in a renal transplant recipient–case report. An Bras Dermatol 2014; 89: 144–146.
- 12Hirschman D, Tacastacas J, Rady PL, et al. Acquired epidermodysplasia verruciformis associated with human papilloma virus type 14 in a small bowel transplanted child—a case report. Pediatr Dermatol 2016; 33: e1–e5.
- 13Henley JK, Hossler EW. Acquired epidermodysplasia verruciformis occurring in a renal transplant recipient. Cutis 2017; 99: E9–E12.
- 14Bushara O, Miller D, Giubellino A, et al. Diagnosis of epidermodysplasia verruciformis: two cases highlighting the role of direct HPV L1 gene sequencing. J Cutan Pathol 2019; 46: 436–441.
- 15Kirchhof MG, Au S. Brazilian waxing and human papillomavirus: a case of acquired epidermodysplasia verruciformis. CMAJ 2015; 187: 126–128.
- 16Henning A, Weaver J, Reedy M. Acquired epidermodysplasia verruciformis in the setting of renal transplant. Am J Dermatopathol 2021; 43: 71–74.
- 17Lau C, Acharya S, Arumainayagam JT, et al. Acquired epidermodysplasia verruciformis in an HIV-positive patient. Int J STD AIDS 2016; 27: 1023–1025.
- 18Charny JW, Rady PL, Tyring SK, et al. Malignant degeneration of diffuse intertriginous flat warts in a patient with AIDS. JAAD Case Rep 2018; 4: 562–564.
- 19Anselmo F, Ansari U, Gagnier JM, et al. Verrucous lesions in an HIV-positive man. JAAD Case Rep. 2019; 825–827.
- 20Tan T, Guitart J, Liu LL, et al. Eccrine syringofibroadenoma in association with acquired epidermodysplasia verruciformis. Am J Dermatopathol 2017; 39: 534–537.
- 21Lowe SM, Katsidzira L, Meys R, et al. Acquired epidermodysplasia verruciformis due to multiple and unusual HPV infection among vertically-infected, HIV-positive adolescents in Zimbabwe. Clin Infect Dis 2012; 54: e119–e123.
- 22Castro-Perez GA, Sorin I, Bravo AI et al. Acquired epidermodysplasia verruciformis in a patient with congenital HIV infection. Actas Dermo-Sifiliográficas 2013; 104: 731–733.
- 23Cowan KR, Gonzalez Santiago TM, Tollefson MM. Acquired epidermodysplasia verruciformis in a child with the human immunodeficiency virus. Pediatr Dermatol 2013; 30: e252–e254.
- 24Ferreira da Silva LC, Espinosa Miranda A, de Lima Ferreira LC, et al. Post-ART epidermodysplasia verruciformis in a patient with AIDS. J Int Assoc Physicians AIDS Care 2010; 9: 10–14.
10.1177/1545109709355709 Google Scholar
- 25Champagne C, Moore L, Reule R, et al. Cornoid lamella-like structures in HIV-associated epidermodysplasia verruciformis: a unique histopathologic finding. Am J Dermatopathol 2015; 37: 929–932.
- 26Kunishige JH, Hymes SR, Madkan V, et al. Epidermodysplasia verruciformis in the setting of graft-versus-host disease. J Am Acad Dermatol 2007; 57(5 suppl): S78–S80.
- 27Cougoul P, Tournier E, Delavigne K, et al. Acquired epidermodysplasia verruciformis, a new opportunistic infection related to bendamustine. Ann Hematol 2015; 94: 1071–1073.
- 28Fernandez KH, Rady P, Tyring S, et al. Acquired epidermodysplasia verruciformis in a child with atopic dermatitis. Pediatr Dermatol 2014; 31: 400–402.
- 29Ferronika P, Sijmons RH, Febiyanto N, et al. Acquired human papilloma virus type 6-associated epidermodysplasia verruciformis in a patient with systemic lupus erythematosus. Am J Dermatopathol 2020; 42: e156–e158.
- 30Schultz B, Nguyen CV, Jacobson-Dunlop E. Acquired epidermodysplasia verruciformis in setting of tumor necrosis factor-α inhibitor therapy. JAAD Case Rep 2018; 805–807.
- 31Berk DR, Bruckner AL, Lu D. Epidermodysplasia verruciform-like Lesions in an HIV patient. Dermatol Online J 2009; 15: 1.
- 32Zahir A, Craig L, Rady P, et al. Epidermodysplasia verruciformis associated with HPV 10. Dermatol Online J 2013; 19: 2.
- 33Limmer AL, Wu JH, Doan HQ, et al. Acquired epidermodysplasia verruciformis: a 10-year anniversary update. Br J Dermatol 2020; 182: 790–792.
- 34Przybyszewska J, Zlotogorski A, Ramot Y. Re-evaluation of epidermodysplasia verruciformis: reconciling more than 90 years of debate. J Am Acad Dermatol 2017; 76: 1161–1175.
- 35Connolly K, Manders P, Earls P, et al. Papillomavirus-associated squamous skin cancers following transplant immunosuppression: one notch closer to control. Cancer Treat Rev 2014; 40: 205–214.
- 36Mertz KD, Schmid M, Burger B, et al. Detection of Merkel cell polyomavirus in epidermodysplasia-verruciformis-associated skin neoplasms. Dermatology 2011; 222: 87–92.
- 37Fang F, Zhao L, Jiang M-J, et al. Epidermodysplasia verruciformis with severe hand and foot deformity successfully treated with surgical excision. J Plast Reconstr Aesthet Surg 2008; 61: 338–341.
- 38Zampetti A, Giurdanella F, Manco S, et al. Acquired epidermodysplasia verruciformis: a comprehensive review and a proposal for treatment. Dermatol Surg 2013; 39: 974–980.
- 39Darwich E, Darwich L, Cañadas MP, et al. New human papillomavirus (HPV) types involved in epidermodysplasia verruciformis (EV) in 3 HIV-infected patients: response to topical cidofovir. J Am Acad Dermatol 2011; 65: e43–e45.
- 40Antoniou C, Kosmadaki MG, Stratigos AJ, et al. Genital HPV lesions and molluscum contagiosum occurring in patients receiving anti-TNF-alpha therapy. Dermatology 2008; 216: 364–365.
- 41Moore RL, de Schaetzen V, Joseph M, et al. Acquired epidermodysplasia verruciformis syndrome in HIV-infected pediatric patients: prospective treatment trial with topical glycolic acid and human papillomavirus genotype characterization. Arch Dermatol 2012; 148: 128–130.
- 42Nijhawan RI, Osei-Tutu A, Hugh JM. Sustained clinical resolution of acquired epidermodysplasia verruciformis in an immunocompromised patient after discontinuation of oral acitretin with topical imiquimod. J Drugs Dermatol 2013; 12: 348–349.
- 43Maor D, Brennand S, Goh MSY, et al. A case of acquired epidermodysplasia verruciformis in a renal transplant recipient clearing with multimodal treatment including HPV (Gardasil) vaccination. Australas J Dermatol 2018; 59: 147–148.
- 44Chido-Amajuoyi OG, Domgue JF, Obi-Jeff C, et al. A call for the introduction of gender-neutral HPV vaccination to national immunisation programmes in Africa. Lancet Glob Health 2019; 7: e20–e21.
- 45Rallis E, Papatheodorou G, Bimpakis E, et al. Systemic low-dose isotretinoin maintains remission status in epidermodysplasia verruciformis. J Eur Acad Dermatol Venereol 2008; 22(4): 523–525.
- 46Bangash HK, Colegio OR. Management of non-melanoma skin cancer in immunocompromised solid organ transplant recipients. Curr Treat Options Oncol 2012; 13: 354–376.
- 47Xu J, Walsh SB, Verney ZM, et al. Procarcinogenic effects of cyclosporine A are mediated through the activation of TAK1/TAB1 signaling pathway. Biochem Biophys Res Comm 2011; 408: 363–368.
- 48Ovits CG, Amin BD, Halverstam C. Acquired epidermodysplasia verruciformis and its relationship to immunosuppressive therapy: report of a case and review of the literature. J Drugs Dermatol 2017; 16: 701–704.
- 49Olivier C, Dellavalle Robert P, Daihung D, et al. What is the evidence for effective treatments of acquired epidermodysplasia verruciformis in HIV-infected patients? Arch Dermatol 2010; 146: 903–905.
Citing Literature
