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Traumatized cervical linear verrucous epidermal nevi – clinical, dermoscopic and treatment challenges

Alin Laurentiu Tatu

Faculty of Medicine and Pharmacy, University ,,Dunarea de Jos “, Galati, Romania

 

Corresponding author: Alin Laurentiu Tatu, MD PhD, E-mail: dralin_tatu@yahoo.com

 

Submission: 19.03.2017; Acceptance: 28.03.2017

DOI: 10.7241/ourd.2017e.9

How to cite this article: Tatu AL. Traumatized cervical linear verrucous epidermal nevi – clinical, dermoscopic and treatment challenges. Our Dermatol Online. 2017;8(1e):e10.


13 years old girl presented with her patients for a traumatized pigmentary, verrucous and inflamed lesion known as a stable mole on the cervical area since the first year of life. The girl reported a little pain on the lesion after she undressed a shirt. On examination there was no bleeding, no lymphadenopathy an erythematous area and away surface at palpation with no other local or general symptoms. Dermoscopy revealed brown yellowish round-oval structures and also in the inferior part of the dermoscopic area a red circular structure covered by small scales an crusts (Fig. 1).

Figure 1: Traumatized verrucous epidermal cervical nevi. (Dermoscopy)

 

A presumptive diagnosis of traumatized cervical linear verrucous epidermal nevi was made and an empirical topical treatment was started with argentic sulfadiazine cream twice daily for two weeks and 10% urea emulsion once daily. After one week the red structure falls down and five weeks later the warty area diminished (Fig. 2).

Figure 2: Linear verrucous epidermal cervical nevi after topical treatment.

 

Dermoscopy revealed fewer round-ovalar brown –yellowish structures and no red color (Fig. 3).

Figure 3: Verrucous epidermal cervical nevi after topical treatment (Dermoscopy)

 

Silver is used to reduce infections from ancient times. The use of silver impregnated dressings after laminectomies appear to limit/reduce the incidence of both postoperative deep and superficial wound infections [1]. The wide spectrum of antibacterial activity the low toxicity, minimal tissue reaction, ease of application suggest that topical silver sulfadiazine can safely be used in burns, surgical wounds and can be extended to other wound infections, wound covers and some transplant materials [2]. At the contact with the bacterian cell Ag + penetrates the bacterial membrane and stop the DNA synthesis so the bacteria cannot divide so it dies. Due to his redox potential Ag+ dissociate after the bacterial destruction and acts in a bactericide manner ensuring a cyclic process. Silver sulfadiazine have excellent anti-bacterial activity and could be used initially while the identification of the infective agent is required for selecting the alternative topical agents and /or systemic therapy [3,4]. Urea is a humectant referred to as hydroxyethyl urea. When it is applied to the skin it penetrates the stratum corneum, where it readily absorbs and retains water, thus increasing the capacity of the skin to hold moisture and rehydrate. One of Urea’s many benefits, is that it helps to accelerate the skins cellular renewal process improving cellular turnover in the epidermis, helping to dramatically improve the water binding ability of the skin. Inflammatory linear verrucous epidermal nevus (ILVEN) is a rare skin disorder [5]. Due to the possibility of repeated trauma and malignancies after puberty the surgical excision was recommended in future.

 

REFERENCES

1. Epstein NE.Do silver impregnated dressings  materials limits infections after lumbar laminectomy with  instrumented fusion?. Surg Neurol. 2007;68:483-5,discussion 485.
2. Fox CL Jr. Topical therapy and the development of silver sulfadiazine. Surg Ginecol Obstet. 1983;157:82-8.
3.Katara G, Chamania S, Chitnis S, Hemvani N, Chitnis V, Dahananjai SC. A comparative study of the effect of different topical agents on burn wound infections. Indian J Plast Surg. 2012;45:374-8.
4. Tatu AL. The use of a topical compound cream product with Chitosan, Silver Sulfadiazine Bentonite hidrogel and Lactic acid for the treatment of a patient with Rosacea and ulcerated Livedoid Vasculopathy. Our Dermatol Online. 2015;6:456-9.
5. Vissers WH, Muys L, Erp PE, de Jong EM, van de Kerkhof PC. Immunohistochemical differentiation between inflammatory linear verrucous epidermal nevus (ILVEN) and psoriasis.Eur J Dermatol. 2004;14:216-20.

 

 

Notes

Source of Support: Nil,

Conflict of Interest: None declared.


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