Epidermodysplasia verruciformis resembling pityriasis versicolor

Epidermodysplasia verruciformis is a rare congenital autosomal recessive disorder that is characterized by an increased susceptibility to infection by certain types of Human Papillomavirus (HPV), typically types 5 and 8. These infections can result in the development of multiple different types of skin lesions ranging from scaly papular lesions to hypopigmented scaly lesions which may mimic Pityriasis versicolor in appearance. Additionally, EV also predisposes towards the development of skin cancers, particularly squamous cell carcinoma.
We describe the case of a 30 year old male of Filipino descent who initially presented to us with a 14 year history of small hypopigmented non-pruritic flat scaly plaques distributed over his neck, upper back and upper limbs. Most lesions were located on the neck. There was no history of preceding injuries or psoriasis. He also had no relevant past medical history or family history of any significant dermatological disorders. The lesions resembled Pityriasis versicolor lesions but the lesions were slightly more elevated than usual. Skin scrapings were negative for Malassezia furfur. Multiple skin biopsies were done. The histopathology showed features typical of Epidermodysplasia verruciformis. He has been advised on sun protection measures and is being monitored for development of skin malignancies. He has been referred to a clinical geneticist as well.

Dr. Joshua Ting