A Case of “Inflammatory Linear Verrucous Epidermal Nevus” (ILVEN) Treated with CO2 Laser Ablation

Gianfaldoni, Serena; Tchernev, Georgi; Gianfaldoni, Roberto; Wollina, Uwe; Lotti, Torello

doi:10.3889/oamjms.2017.078

Cited by 18 publications

(15 citation statements)

References 25 publications

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“…20 Surgical excision, cryotherapy, and CO 2 laser therapy are also therapeutic choices. 3,28 In conclusion, we report an unusual case of ILVEN presenting in a 49-year-old woman and demonstrate the utility of immunohistochemical staining with involucrin, Ki-67, and keratin-10 in histopathologic differentiation from psoriasis.…”

Section: Discussionmentioning

confidence: 61%

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Adult‐onset inflammatory linear verrucous epidermal nevus: Immunohistochemical studies and review of the literature

2020

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Adult-onset inflammatory linear verrucous epidermal nevus (ILVEN) is an uncommon cutaneous disease compared to childhood-onset ILVEN. The typical histopathologic features are alternating parakeratosis and orthokeratosis with an absent granular layer underneath parakeratosis, in contrast to a thickened granular layer below the foci of orthokeratosis in psoriasiform epidermal hyperplasia. Herein, we present a 49-year-old woman with typical clinical and histopathologic characteristics of adultonset ILVEN, including linear arrangement of thick scaly papules and plaques localized on the medial side of her right leg, ankle, and foot. Immunohistochemical studies included involucrin, Ki-67, and keratin-10. Compared to the staining pattern in psoriasis, the expression of involucrin in this case was of lower intensity and localized to upper epidermal layers with relatively less extensive staining beneath regions of parakeratosis as compared to orthokeratosis; Ki-67 showed lower basal layer proliferative activity; and keratin-10 showed a greater intensity of staining within suprabasal epidermis.

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Section: Discussionmentioning

confidence: 61%

“…Topical and intralesional corticosteroids, topical tretinoin 0.1% in combination with fluorouracil 5%, topical anthralin, tar, and vitamin D3 analogues have been used, but recurrence is common 20 . Surgical excision, cryotherapy, and CO 2 laser therapy are also therapeutic choices 3,28 …”

Section: Discussionmentioning

confidence: 99%

Adult‐onset inflammatory linear verrucous epidermal nevus: Immunohistochemical studies and review of the literature

2020

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“…The use of lasers in treating epidermal nevi has been reported, but successful eradication appears dependent on the clinical characteristics of the nevus. Softer, flat nevi seem to be more responsive than firm, keratotic forms [5,15]. Er:YAG laser ablation has a comparable clinical improvement with CO 2 laser, but the rate of recurrence is higher with Er:YAG laser [14].…”

Section: Case Discussionmentioning

confidence: 91%

Linear verrucous epidermal nevus with oral manifestations: report of two cases

Gomes¹,

Vargas²,

Tomimori³

et al. 2020

Dermatology Online Journal

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“…Inflammatory linear verrucous epidermal nevus (ILVEN) is a collection of persistent, hyperkeratotic, pruritic, erythematous papules in a linear or whorled array, following the lines of Blaschko. Treatment of ILVEN is challenging and numerous therapies have been suggested with varying degrees of success . We present a case of ILVEN in a 5‐year‐old‐boy, treated successfully with crisaborole 2% ointment.…”

Section: Introductionmentioning

confidence: 99%

Inflammatory linear verrucous epidermal nevus treated successfully with crisaborole ointment in a 5‐year‐old boy

Barney

Prose

Ramirez

2019

Pediatric Dermatology

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Inflammatory linear verrucous epidermal nevus (ILVEN) is a chronic, a linear, or whorled array of inflammatory, following the lines of Blaschko. Treatment of ILVEN is challenging with numerous therapies of varying degrees of success reported. We present a case of ILVEN in a 5-year-old-boy, treated successfully with crisaborole 2% ointment. This brief report suggests that there may be additional cellular immunologic pathways responsible for the presentation of ILVEN that may be explained by management with crisaborole use. | 405Pediatric Dermatology BRIEF REPORT triamcinolone 0.1% ointment, tazarotene 0.05% cream, calcipotriene 0.005% ointment, betamethasone valerate 0.1% ointment, and ammonium lactate 12% cream. The patient was then prescribed crisaborole 2% ointment BID for lesions on his face only. Within 2 months, there was significant improvement (Figure 2). Crisaborole use was then expanded to all areas of involvement. At 3-month follow-up, all plaques were noted to be less erythematous, and flattening of the lesions was observed. Pruritus had resolved completely. | D ISCUSS I ONCrisaborole is a PDE-4 enzyme inhibitor that results in increased intracellular cyclic adenosine monophosphate (cAMP) levels, thereby decreasing the production of inflammatory cytokines and chemokines such as interleukin (IL) 4 (IL-4), IL-31, and prostaglandin E2 (PGE-2). 2,3 Crisaborole is approved for treatment of atopic dermatitis (AD) and has demonstrated sustained improvement in disease severity, pruritus, and other AD symptoms. 4,5 The pathogenesis of ILVEN is not well understood. The disorder is thought to be associated with upregulation of IL-1, IL-6, tumor necrosis factor-[alpha], and intercellular adhesion molecule 1. 2,3 We postulate that crisaborole may play an important role in downregulating these specific inflammatory cytokines. Specific studies regarding the role of PDE-4 enzyme inhibitors in the treatment of AD identified a decrease or reversal in the production of IL-2, IL-4, IL-5, IL-10, PGE-2, TNFα, and IFNγ. 2,3 These results, though examined in reference to the treatment of AD, highlight the antiinflammatory effects of crisaborole. It is possible that there is inhibition of additional cellular immunologic pathways responsible for the presentation of ILVEN, or that the previously listed cytokines and chemokines play a role in the pathology of ILVEN and are therefore managed with crisaborole use. Although we are reporting success in only a single case, we believe that further studies of the use of crisaborole ointment 2% in ILVEN are warranted.

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A Case of “Inflammatory Linear Verrucous Epidermal Nevus” (ILVEN) Treated with CO2 Laser Ablation

Cited by 18 publications

References 25 publications

Adult‐onset inflammatory linear verrucous epidermal nevus: Immunohistochemical studies and review of the literature

Adult‐onset inflammatory linear verrucous epidermal nevus: Immunohistochemical studies and review of the literature

Linear verrucous epidermal nevus with oral manifestations: report of two cases

Inflammatory linear verrucous epidermal nevus treated successfully with crisaborole ointment in a 5‐year‐old boy

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