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February 2000

Truncal Hypopigmented Macules and Facial Hyperpigmented Papules

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Arch Dermatol. 2000;136(2):259-264. doi:

Histologic examination of the specimen from the trunk revealed enlarged keratinocytes with lightly basophilic cytoplasm. Examination of the facial papule specimen revealed keratinocytes with perinuclear vacuolation as well as enlarged and atypical nuclei. Viral typing by direct DNA sequencing of the products of polymerase chain reaction revealed infection with human papillomavirus (HPV) types 5 and 14d.

Epidermodysplasia verruciformis is a rare condition in which patients are predisposed to chronic cutaneous infection with HPV. It is most commonly inherited in an autosomal recessive manner,1 although X-linked inheritance has also been described.2 Affected individuals develop progressive cutaneous lesions of varying clinical appearance. The lesions may resemble planar warts or pityriasis versicolor. They may also develop into actinic keratoses or squamous cell carcinomas, typically on sun-exposed sites. The microscopic appearance can vary from perinuclear vacuolation of keratinocytes to enlargement of cells with basophilic cytoplasm to progressive changes of atypia. Patients do not show features of generalized immunosuppression.