Giant Inflammatory Linear Verrucous Epidermal Nevus: Successfully Treated with Full Thickness Excision and Skin Grafting
A 17 year old female presented with a linear pruritic lesion extending from lateral border of right foot to right gluteal region []. The parents noticed that lesion in the second month of life, which continued to grow up to puberty. Since last 2 years it was stable. Pruritus was intense leading to recurrent secondary infection. There were no other systemic abnormalities. None of the family members had similar type of lesion. She was prescribed oral, topical and intralesional steroid, isotretinoin and methotrexate in past, without any improvement. The routine investigations including tests for HIV were within normal limits.\nHistopathology showed hyperkeratosis with alternate parakeratosis and orthokeratosis and hypergranulosis beneath the orthokeratotic area. There was mild spongiosis with psoriasiform epidermal hyperplasia and mild to moderate perivascular lymphocytic infiltrate in superficial dermis [].\nA diagnosis of ILVEN was made on the basis of intense pruritus, histopathological findings and lack of response to antipsoriatic treatments. Considering the marriageable age, posteriorly placed lesion and malignant potential, she had underwent full thickness excision followed by split thickness skin grafting. The postoperative period was uneventful. She was followed up for one year without any recurrence or significant scarring []. The cosmetic result was acceptable and the patient was satisfied.