Acquired epidermodysplasia verruciformis in setting of tumor necrosis factor-α inhibitor therapy

Cervical dysplasia in a patient with inherited epidermodysplasia verruciformis—A mere coincidence?

“…An acquired form of EV presents relatively later in life. Patients with acquired EV have an immunocompromised state such as human immunodeficiency virus (HIV) infection, organ transplant 31‐33 or an impaired T‐cell mediated immunity, the latter also known as atypical EV (AEV) 12,34,35 . These acquired variants suggest that multiple innate and adaptive immune processes in the skin confer immunity against beta HPV infection in healthy individuals.…”

“…Patients with acquired EV have an immunocompromised state such as human immunodeficiency virus (HIV) infection, organ transplant [31][32][33] or an impaired T-cell mediated immunity, the latter also known as atypical EV (AEV). 12,34,35 These acquired variants suggest that multiple innate and adaptive immune processes in the skin confer immunity against beta HPV infection in healthy individuals. Lack of these factors due to genetic mutations, immunosuppression, or lack of T-cell dependent immunity can lead to susceptibility to infection by beta type HPVs and cutaneous lesions of EV.…”

Nonpruritic hypopigmented macules on an immunocompromised patient

“… 1 , 5 In transplant patients, changing immunosuppressive medications, specifically from azathioprine to mycophenolate mofetil, has also been proposed as a viable treatment recommendation. 2 Other treatments include glycolic acid 15%, 2 , 7 combination therapy involving glycolic acid and imiquimod, 1 , 2 , 5 high-dose oral cimetidine, and interferon. 3 , 7 In our case, dosage of acitretin 25 mg three times weekly (Monday, Wednesday, Friday) was started.…”

Erythematous Plaques on a Tattoo

“…Acquired EV is a rare dermatologic condition associated with specific human papillomavirus (HPV) types that presents with recalcitrant lesions most commonly in the setting of immunosuppression. 1 The most common HPV types associated with EV are HPV-5 and -8, but associations with HPV-3, -9, -10, -12, -14, -15, -17, -19 to -25, -36 to -38, -47, and -50 also have been reported. 1,2 Acquired EV has been identified in individuals with human immunodeficiency virus, as well as in immunosuppressed patients with organ transplantation, Hodgkin lymphoma, systemic lupus erythematosus, and IgM deficiency, and in patients taking immunosuppressive medications such as tumor necrosis factor α inhibitors.…”

“…1 The most common HPV types associated with EV are HPV-5 and -8, but associations with HPV-3, -9, -10, -12, -14, -15, -17, -19 to -25, -36 to -38, -47, and -50 also have been reported. 1,2 Acquired EV has been identified in individuals with human immunodeficiency virus, as well as in immunosuppressed patients with organ transplantation, Hodgkin lymphoma, systemic lupus erythematosus, and IgM deficiency, and in patients taking immunosuppressive medications such as tumor necrosis factor α inhibitors. 1,3 The diagnosis is clinicopathological with potential polymerase chain reaction studies to identify underlying HPV types.…”