Unilateral Perianogenital Papulokeratotic Lesion

REPORT OF A CASE A 7-year-old girl presented with a slowly growing unilateral verrucous lesion in the vulvoanal region ( Figure 1 ). Intermittent reddening, itching, and oozing of the lesion was reported. Histologic examination was performed for suspected neurodermatitis. Treatment with tar preparations and locally applied corticosteroids was unsuccessful. Exacerbation of the inflammatory manifestations and gradual growth of the lesion were observed. Cultures were negative for bacteria and yeasts. The diagnosis had to be reevaluated and a biopsy specimen was obtained ( Figure 2 ). What is your diagnosis? Unilateral Perianogenital Papulokeratotic Lesion DIAGNOSIS: Inflammatory linear verrucous epidermal nevus (ILVEN). HISTOPATHOLOGIC FINDINGS A second biopsy specimen (Figure 2) revealed hyperkeratosis and parakeratosis without the presence of neutrophils, acanthosis, papillomatosis, very slight spongiosis, and lymphohistiocytic infiltration of the upper dermis. The psoriasiform picture together with the clinical picture supported the diagnosis of ILVEN. DISCUSSION Inflammatory linear verrucous epidermal nevus usually develops in childhood. It is characterized by slowly