Congenital and Acquired Epidermodysplasia Verruciformis: A Series of 7 Cases

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A y B. Máculas hipopigmentadas tipo pitiriasis versicolor en paciente con fototipo alto y fototipo bajo, respectivamente. C. Lesiones tipo verruga plana en el dorso de la mano. D. Lesiones tipo queratosis seborreica y máculas hipopigmentadas tipo pitiriasis versicolor en paciente con fototipo alto. E. Histología característica de epidermodisplasia verruciforme; queratinocitos engrosados con citoplasma azul-grisáceo en el estrato espinoso con gránulos queratohialinos en su interior (hematoxilina-eosina, ×20)." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Alturo-Pons, F. Alamon-Reig, V. Sanmartín Novell, F. Vilardell, R.M. Martí" "autores" => array:5 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Alturo-Pons" ] 1 => array:2 [ "nombre" => "F." "apellidos" => "Alamon-Reig" ] 2 => array:2 [ "nombre" => "V." "apellidos" => "Sanmartín Novell" ] 3 => array:2 [ "nombre" => "F." "apellidos" => "Vilardell" ] 4 => array:2 [ "nombre" => "R.M." 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A y B. Máculas hipopigmentadas tipo pitiriasis versicolor en paciente con fototipo alto y fototipo bajo, respectivamente. C. Lesiones tipo verruga plana en el dorso de la mano. D. Lesiones tipo queratosis seborreica y máculas hipopigmentadas tipo pitiriasis versicolor en paciente con fototipo alto. E. Histología característica de epidermodisplasia verruciforme; queratinocitos engrosados con citoplasma azul-grisáceo en el estrato espinoso con gránulos queratohialinos en su interior (hematoxilina-eosina, ×20)." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Alturo-Pons, F. Alamon-Reig, V. Sanmartín Novell, F. Vilardell, R.M. Martí" "autores" => array:5 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Alturo-Pons" ] 1 => array:2 [ "nombre" => "F." "apellidos" => "Alamon-Reig" ] 2 => array:2 [ "nombre" => "V." "apellidos" => "Sanmartín Novell" ] 3 => array:2 [ "nombre" => "F." "apellidos" => "Vilardell" ] 4 => array:2 [ "nombre" => "R.M." 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"apellidos" => "Martí" "email" => array:1 [ 0 => "marti@medicina.udl.cat" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, IRBLleida, Lleida, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, IRBLleida, Lleida, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Epidermodisplasia verruciforme congénita y adquirida: serie de 7 casos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1665 "Ancho" => 1406 "Tamanyo" => 568969 ] ] "descripcion" => array:1 [ "en" => "Epidermodysplasia verruciformis. A and B, Pityriasis versicolor-like hypopigmented macules in 2 patients with a low and high Fitzpatrick skin type. C, Verruca plana-like lesions on the dorsum of the hand. D, Seborrheic keratosis-like lesions and hypopigmented pityriasis versicolor-like macules in a patient with a high Fitzpatrick skin type. E, Characteristic histology findings in epidermodysplasia verruciformis. Note the thickened keratinocytes with grayish-blue cytoplasm in the stratum spinosum and keratohyaline granules in the interior (hematoxylin–eosin, original magnification ×20)." ] ] ] "textoCompleto" => "Epidermodysplasia verruciformis (EV) is an autosomal recessive genodermatosis characterized by high susceptibility to β human papillomaviruses (HPV).<a class="elsevierStyleCrossRef" href="#bib0055">1</a> Characteristic clinical manifestations include polymorphic pityriasis versicolor–like lesions and verruca plana–like papules. Both appear in childhood and have malignant potential, with 30% to 70% of patients developing a malignancy in adulthood.<a class="elsevierStyleCrossRefs" href="#bib0060">2,3</a> EV-like is an acquired form of EV that occur in patients with acquired cell-mediated immunity defects.<a class="elsevierStyleCrossRef" href="#bib0055">1</a>We reviewed medical records and available images for all patients with histologically confirmed EV and EV-like at Hospital Universitari Arnau de Vilanova, in Lleida, Spain. Seven patients were studied. Their characteristics are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> and illustrated in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia>EV is an inherited genetic condition characterized by abnormal susceptibility to β HPV types,<a class="elsevierStyleCrossRef" href="#bib0055">1</a> mostly HPV-5 and HPV-8, but others have been identified.<a class="elsevierStyleCrossRef" href="#bib0055">1</a> Merkel cell polyomavirus DNA has also been found in patients with EV and EV-like lesions.<a class="elsevierStyleCrossRef" href="#bib0055">1</a> Classic EV is inherited in an autosomal recessive manner due to homozygous inactivating mutations in the EVER1/TMC6 and EVER2/TMC8 genes located on chromosome 17q25.<a class="elsevierStyleCrossRef" href="#bib0055">1</a> These genes are expressed in keratinocytes and immune cells encoding proteins that regulate intracellular zinc. The proteins are involved in the induction of proapoptotic factors and inhibit the transcription of HPV4 genes.<a class="elsevierStyleCrossRef" href="#bib0070">4</a> A nonclassic form of EV associated with RHOH, MST-1, and CORO1A was recently described.<a class="elsevierStyleCrossRefs" href="#bib0055">1,5</a> EV-like is an an acquired form of EV that occur in predisposed patients with cell-mediated immunity defects. The main immunosuppressive factor is HIV infection.<a class="elsevierStyleCrossRef" href="#bib0055">1</a> In our series, 4 of the 5 patients with EV-like had HIV infection. “The main clinical manifestations of both EV and EV-like lesions are pink, scaling, hypopigmented” or hyperpigmented pityriasis versicolor–like macules and erythematous or whitish verruca plana–like papules.<a class="elsevierStyleCrossRef" href="#bib0055">1</a> All 7 patients in our series had pityriasis versicolor–like lesions and 4 had verruca plana–like lesions (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A–C). These findings are consistent with those of the series described by Lutzner et al.,<a class="elsevierStyleCrossRef" href="#bib0080">6</a> where all the patients had pityriasis versicolor–like lesions and many had verruca plana–like lesions. Pigmented, hyperkeratotic seborrheic keratosis–like papules have also been described in EV, mainly in black patients and patients with phenotypes associated with a worse prognosis.<a class="elsevierStyleCrossRef" href="#bib0055">1</a> Patients #2 (EV) and #3 (EV-like) in our series, both with a high Fitzpatrick skin type, developed seborrheic keratosis–like lesions (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>D). Lesions are usually disseminated in EV, although there have been reports of localized eruptions.<a class="elsevierStyleCrossRef" href="#bib0085">7</a> The 2 patients with EV in our series had disseminated lesions, and 4 of the 5 patients with an EV-like eruption had localized lesions. EV and EV-like are associated with increased susceptibility to nonmelanoma skin cancer (NMSC). Two patients in our series developed NMSC. Patient #1 developed cutaneous squamous cell carcinoma (SCC), while patient #6 developed SCC in the oral mucosa (a sun-protected area). It is worth noting that the latter patient only developed pityriasis versicolor–like lesions in the mandibular region, which had previously been treated with radiation therapy. Risk of NMSC is also influenced by HPV type. Types HPV-5, HPV-8, HPV-10, and HPV-47 have been identified in more than 90% of EV-associated malignancies.<a class="elsevierStyleCrossRef" href="#bib0090">8</a> Sun exposure is the main risk factor for NMSC in patients with EV and EV-like lesions. Patients with high Fitzpatrick skin types may be more likely to have a benign course due to the UV protection conferred by increased pigmentation.<a class="elsevierStyleCrossRef" href="#bib0065">3</a> The patient who developed cutaneous SCC in our series had a low Fitzpatrick skin type. Those with higher types (patients #2 and #3) did not develop any malignancies during follow-up. Diagnosis of EV and EV-like lesions is clinical and usually confirmed histologically. Typical histologic findings in EV are hyperkeratosis, epidermal acanthosis with keratinocytes with a bluish cytoplasm and keratohyaline granules, and cytologic atypia (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>E).<a class="elsevierStyleCrossRef" href="#bib0055">1</a> Dermoscopy was recently described as a useful diagnostic tool for EV.<a class="elsevierStyleCrossRef" href="#bib0095">9</a> Management of EV and EV-like consists of regular dermatology check-ups and strict sun protection measures to prevent NMSC. Although there are no specific treatments for EV, it has been suggested that systemic retinoids might be useful prophylactics for high-risk patients due to their antiproliferative and differentiation-inducing effects.<a class="elsevierStyleCrossRef" href="#bib0100">10</a>Dermatologists must be familiar with the clinical presentation of congenital and acquired EV. Early diagnosis and initiation of preventive measures are key to prognosis and management.Conflicts of InterestThe authors declare that they have no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of Interest" ] 1 => array:2 [ "identificador" => "xack652804" "titulo" => "Acknowledgments" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:3 [ "etiqueta" => "◊" "nota" => "Both authors contributed equally to this work." "identificador" => "fn0005" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1665 "Ancho" => 1406 "Tamanyo" => 568969 ] ] "descripcion" => array:1 [ "en" => "Epidermodysplasia verruciformis. A and B, Pityriasis versicolor-like hypopigmented macules in 2 patients with a low and high Fitzpatrick skin type. C, Verruca plana-like lesions on the dorsum of the hand. D, Seborrheic keratosis-like lesions and hypopigmented pityriasis versicolor-like macules in a patient with a high Fitzpatrick skin type. E, Characteristic histology findings in epidermodysplasia verruciformis. Note the thickened keratinocytes with grayish-blue cytoplasm in the stratum spinosum and keratohyaline granules in the interior (hematoxylin–eosin, original magnification ×20)." ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Abbreviations: CIN, cervical intraepithelial neoplasia; EV, epidermodysplasia verruciformis; F, female; HBV, hepatitis B virus; HCV, hepatitis C virus; IHC, immunohistochemistry; M, male; NMSC, nonmelanoma skin cancer; NHL, non-Hodgkin lymphoma." "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">EV/EV-like lesions \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sex \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Age at symptom onset, y \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">History of EV \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Skin type \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Skin lesions \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Comorbidities \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">NMSC during follow-up \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">EV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes (mother) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Erythematous scaling maculopapular rash on the trunk and top of the upper and lower limbs. Filiform warts on both shoulders. Flat warts on the dorsum of the hands and top of the limbs. Plantar keratoderma. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hypertension \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes (SCC on lower limb) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">EV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hypopigmented maculopapular lesions located predominantly on the trunk and in the cervical region. Cervical seborrheic keratosis–like lesions and flat warts on the dorsum of the hand. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">EV-like \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hypopigmented maculopapular lesions located bilaterally in the lower abdominal and inguinal region. Seborrheic keratosis–like lesions in the bilateral inguinal region. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HIV, CIN-I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">EV-like \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hypopigmented maculopapular lesions located predominantly on the upper trunk and top of the limbs. Flat warts on the dorsum of the hand. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HIV, HBC, HVC, CIN-III \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">EV-like \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Confluent, salmon-colored papular lesions, some with central umbilication, in the upper region of the trunk. Flat warts on the dorsum of the hand. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HIV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">EV-like \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hypopigmented maculopapular lesions in the right neck region. Filiform wart on the forehead. Common wart on the tip of the fourth finger of the left hand. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NHL, autologous bone marrow transplant, lung transplant, polychemotherapy, splenectomy, treatment with tacrolimus and methylprednisolone \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes (oral SCC) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">EV-like \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hypopigmented maculopapular lesions measuring 3 to 4mm in the perianal area, the inner aspect of the labia majora, and the vulva. Pink maculopapular lesions on the pubis and inner thighs. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HIV, HVC, CIN-I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "en" => "Characteristics of Patients With EV and EV-Like Lesions." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Re-evaluation of epidermodysplasia verruciformis: reconciling more than 90 years of debate" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Przybyszewska" 1 => "A. Zlotogorski" 2 => "Y. Ramot" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2016.12.035" "Revista" => array:5 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2017" "volumen" => "76" "paginaInicial" => "1161" "paginaFinal" => "1175" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidermodisplasia verruciforme" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "V.P. Sánchez-García" 1 => "A. Sanz" 2 => "C. Eloy" 3 => "Á. Vera" 4 => "T. Martín" 5 => "F. 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"vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/00017310/0000011400000002/v3_202302211823/S0001731022010110/v3_202302211823/en/main.assets" "Apartado" => array:4 [ "identificador" => "6160" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Cartas científico-clínicas" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/00017310/0000011400000002/v3_202302211823/S0001731022010110/v3_202302211823/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731022010110?idApp=UINPBA000044"]

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Case and Research Letter

Congenital and Acquired Epidermodysplasia Verruciformis: A Series of 7 Cases

Epidermodisplasia verruciforme congénita y adquirida: serie de 7 casos

A. Alturo-Ponsa,◊, F. Alamon-Reigb,◊, V. Sanmartín Novella, F. Vilardellc, R.M. Martía,

Autor para correspondencia

marti@medicina.udl.cat

Corresponding author.

a Servicio de Dermatología, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, IRBLleida, Lleida, Spain

b Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain

c Servicio de Anatomía Patológica, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, IRBLleida, Lleida, Spain

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    "titulo" => " Congenital and Acquired Epidermodysplasia Verruciformis&#58; A Series of 7 Cases"
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        "titulo" => "Epidermodisplasia verruciforme cong&#233;nita y adquirida&#58; serie de 7 casos"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Epidermodysplasia verruciformis&#46; A and B&#44; Pityriasis versicolor-like hypopigmented macules in 2 patients with a low and high Fitzpatrick skin type&#46; C&#44; Verruca plana-like lesions on the dorsum of the hand&#46; D&#44; Seborrheic keratosis-like lesions and hypopigmented pityriasis versicolor-like macules in a patient with a high Fitzpatrick skin type&#46; E&#44; Characteristic histology findings in epidermodysplasia verruciformis&#46; Note the thickened keratinocytes with grayish-blue cytoplasm in the stratum spinosum and keratohyaline granules in the interior &#40;hematoxylin&#8211;eosin&#44; original magnification &#215;20&#41;&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Epidermodysplasia verruciformis &#40;EV&#41; is an autosomal recessive genodermatosis characterized by high susceptibility to &#946; human papillomaviruses &#40;HPV&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Characteristic clinical manifestations include polymorphic pityriasis versicolor&#8211;like lesions and verruca plana&#8211;like papules&#46; Both appear in childhood and have malignant potential&#44; with 30&#37; to 70&#37; of patients developing a malignancy in adulthood&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2&#44;3</span></a> EV-like is an acquired form of EV that occur in patients with acquired cell-mediated immunity defects&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We reviewed medical records and available images for all patients with histologically confirmed EV and EV-like at Hospital Universitari Arnau de Vilanova&#44; in Lleida&#44; Spain&#46; Seven patients were studied&#46; Their characteristics are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> and illustrated in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">EV is an inherited genetic condition characterized by abnormal susceptibility to &#946; HPV types&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> mostly HPV-5 and HPV-8&#44; but others have been identified&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Merkel cell polyomavirus DNA has also been found in patients with EV and EV-like lesions&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Classic EV is inherited in an autosomal recessive manner due to homozygous inactivating mutations in the <span class="elsevierStyleItalic">EVER1</span>&#47;<span class="elsevierStyleItalic">TMC6</span> and <span class="elsevierStyleItalic">EVER2</span>&#47;<span class="elsevierStyleItalic">TMC8</span> genes located on chromosome 17q25&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> These genes are expressed in keratinocytes and immune cells encoding proteins that regulate intracellular zinc&#46; The proteins are involved in the induction of proapoptotic factors and inhibit the transcription of <span class="elsevierStyleItalic">HPV4</span> genes&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> A nonclassic form of EV associated with <span class="elsevierStyleItalic">RHOH</span>&#44; <span class="elsevierStyleItalic">MST-1</span>&#44; and <span class="elsevierStyleItalic">CORO1A</span> was recently described&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;5</span></a> EV-like is an an acquired form of EV that occur in predisposed patients with cell-mediated immunity defects&#46; The main immunosuppressive factor is HIV infection&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> In our series&#44; 4 of the 5 patients with EV-like had HIV infection&#46; &#8220;The main clinical manifestations of both EV and EV-like lesions are pink&#44; scaling&#44; hypopigmented&#8221; or hyperpigmented pityriasis versicolor&#8211;like macules and erythematous or whitish verruca plana&#8211;like papules&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> All 7 patients in our series had pityriasis versicolor&#8211;like lesions and 4 had verruca plana&#8211;like lesions &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#8211;C&#41;&#46; These findings are consistent with those of the series described by Lutzner et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> where all the patients had pityriasis versicolor&#8211;like lesions and many had verruca plana&#8211;like lesions&#46; Pigmented&#44; hyperkeratotic seborrheic keratosis&#8211;like papules have also been described in EV&#44; mainly in black patients and patients with phenotypes associated with a worse prognosis&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Patients &#35;2 &#40;EV&#41; and &#35;3 &#40;EV-like&#41; in our series&#44; both with a high Fitzpatrick skin type&#44; developed seborrheic keratosis&#8211;like lesions &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>D&#41;<span class="elsevierStyleItalic">&#46;</span> Lesions are usually disseminated in EV&#44; although there have been reports of localized eruptions&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> The 2 patients with EV in our series had disseminated lesions&#44; and 4 of the 5 patients with an EV-like eruption had localized lesions&#46; EV and EV-like are associated with increased susceptibility to nonmelanoma skin cancer &#40;NMSC&#41;&#46; Two patients in our series developed NMSC&#46; Patient &#35;1 developed cutaneous squamous cell carcinoma &#40;SCC&#41;&#44; while patient &#35;6 developed SCC in the oral mucosa &#40;a sun-protected area&#41;&#46; It is worth noting that the latter patient only developed pityriasis versicolor&#8211;like lesions in the mandibular region&#44; which had previously been treated with radiation therapy&#46; Risk of NMSC is also influenced by HPV type&#46; Types HPV-5&#44; HPV-8&#44; HPV-10&#44; and HPV-47 have been identified in more than 90&#37; of EV-associated malignancies&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> Sun exposure is the main risk factor for NMSC in patients with EV and EV-like lesions&#46; Patients with high Fitzpatrick skin types may be more likely to have a benign course due to the UV protection conferred by increased pigmentation&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> The patient who developed cutaneous SCC in our series had a low Fitzpatrick skin type&#46; Those with higher types &#40;patients &#35;2 and &#35;3&#41; did not develop any malignancies during follow-up&#46; Diagnosis of EV and EV-like lesions is clinical and usually confirmed histologically&#46; Typical histologic findings in EV are hyperkeratosis&#44; epidermal acanthosis with keratinocytes with a bluish cytoplasm and keratohyaline granules&#44; and cytologic atypia &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>E&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Dermoscopy was recently described as a useful diagnostic tool for EV&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> Management of EV and EV-like consists of regular dermatology check-ups and strict sun protection measures to prevent NMSC&#46; Although there are no specific treatments for EV&#44; it has been suggested that systemic retinoids might be useful prophylactics for high-risk patients due to their antiproliferative and differentiation-inducing effects&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Dermatologists must be familiar with the clinical presentation of congenital and acquired EV&#46; Early diagnosis and initiation of preventive measures are key to prognosis and management&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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          "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; CIN&#44; cervical intraepithelial neoplasia&#59; EV&#44; epidermodysplasia verruciformis&#59; F&#44; female&#59; HBV&#44; hepatitis B virus&#59; HCV&#44; hepatitis C virus&#59; IHC&#44; immunohistochemistry&#59; M&#44; male&#59; NMSC&#44; nonmelanoma skin cancer&#59; NHL&#44; non-Hodgkin lymphoma&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hypopigmented maculopapular lesions located predominantly on the trunk and in the cervical region&#46; Cervical seborrheic keratosis&#8211;like lesions and flat warts on the dorsum of the hand&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">EV-like&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hypopigmented maculopapular lesions located bilaterally in the lower abdominal and inguinal region&#46; Seborrheic keratosis&#8211;like lesions in the bilateral inguinal region&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HIV&#44; CIN-I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">EV-like&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hypopigmented maculopapular lesions located predominantly on the upper trunk and top of the limbs&#46; Flat warts on the dorsum of the hand&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HIV&#44; HBC&#44; HVC&#44; CIN-III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">EV-like&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Confluent&#44; salmon-colored papular lesions&#44; some with central umbilication&#44; in the upper region of the trunk&#46; Flat warts on the dorsum of the hand&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HIV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">EV-like&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hypopigmented maculopapular lesions in the right neck region&#46; Filiform wart on the forehead&#46; Common wart on the tip of the fourth finger of the left hand&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NHL&#44; autologous bone marrow transplant&#44; lung transplant&#44; polychemotherapy&#44; splenectomy&#44; treatment with tacrolimus and methylprednisolone&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes &#40;oral SCC&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">EV-like&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hypopigmented maculopapular lesions measuring 3 to 4<span class="elsevierStyleHsp" style=""></span>mm in the perianal area&#44; the inner aspect of the labia majora&#44; and the vulva&#46; Pink maculopapular lesions on the pubis and inner thighs&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HIV&#44; HVC&#44; CIN-I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Characteristics of Patients With EV and EV<span class="elsevierStyleItalic">-</span>Like Lesions&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:10 [
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              "identificador" => "bib0055"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Re-evaluation of epidermodysplasia verruciformis&#58; reconciling more than 90 years of debate"
                      "autores" => array:1 [
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                            0 => "J&#46; Przybyszewska"
                            1 => "A&#46; Zlotogorski"
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                  "host" => array:1 [
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                      "Revista" => array:5 [
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            1 => array:3 [
              "identificador" => "bib0060"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epidermodisplasia verruciforme"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "V&#46;P&#46; S&#225;nchez-Garc&#237;a"
                            1 => "A&#46; Sanz"
                            2 => "C&#46; Eloy"
                            3 => "&#193;&#46; Vera"
                            4 => "T&#46; Mart&#237;n"
                            5 => "F&#46; S&#225;nchez-Fajardo"
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                            "web" => "Medline"
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            2 => array:3 [
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acquired epidermodysplasia verruciformis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "H&#46;D&#46; Rogers"
                            1 => "J&#46;L&#46; Macgregor"
                            2 => "K&#46;M&#46; Nord"
                            3 => "S&#46; Tyring"
                            4 => "P&#46; Rady"
                            5 => "D&#46;E&#46; Engler"
                          ]
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                  ]
                  "host" => array:1 [
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                      "doi" => "10.1016/j.jaad.2008.08.035"
                      "Revista" => array:6 [
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                        "fecha" => "2009"
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            3 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Regulation of cellular zinc balance as a potential mechanism of EVER-mediated protection against pathogenesis by cutaneous oncogenic human papillomaviruses"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46; Lazarczyk"
                            1 => "C&#46; Pons"
                            2 => "J&#46;A&#46; Mendoza"
                            3 => "P&#46; Cassonnet"
                            4 => "Y&#46; Jacob"
                            5 => "M&#46; Favre"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1084/jem.20071311"
                      "Revista" => array:5 [
                        "tituloSerie" => "J Exp Med"
                        "fecha" => "2008"
                        "volumen" => "205"
                        "paginaInicial" => "35"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18158319"
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                        ]
                      ]
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            ]
            4 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
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                      "titulo" => "A novel approach to the classification of epidermodysplasia verruciformis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "S&#46; Huang"
                            1 => "J&#46;H&#46; Wu"
                            2 => "D&#46;J&#46; Lewis"
                            3 => "P&#46;L&#46; Rady"
                            4 => "S&#46;K&#46; Tyring"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/ijd.14196"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Dermatol"
                        "fecha" => "2018"
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Información del artículo

ISSN: 00017310
Idioma original: Inglés

DOI:10.1016/j.ad.2022.01.055

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