Dean SM, Zirwas MJ, Horst AV, et al.
Journal of the American Academy of Dermatology. Date of publication 2011 Jun 1;volume 64(6):1104-10.
1. J Am Acad Dermatol. 2011 Jun;64(6):1104-10. doi: 10.1016/j.jaad.2010.04.047. Epub
2011 Mar 25.
Elephantiasis nostras verrucosa: an institutional analysis of 21 cases.
Dean SM(1), Zirwas MJ, Horst AV.
Author information:
(1)Department of Cardiovascular Medicine, Ohio State University College of
Medicine, Columbus, Ohio 43210, USA. steven.dean@osumc.edu
BACKGROUND: Previous reports regarding elephantiasis nostras verrucosa (ENV) have
been typically limited to 3 or fewer patients.
OBJECTIVES: We sought to statistically ascertain what demographic features and
clinical variables are associated with ENV.
METHODS: A retrospective chart review of 21 patients with ENV from 2006 to 2008
was performed and statistically analyzed.
RESULTS: All 21 patients were obese (morbid obesity in 91%) with a mean body mass
index of 55.8. The average maximal calf circumference was 63.7 cm. Concurrent
chronic venous insufficiency was identified in 15 patients (71%). ENV was
predominantly bilateral (86%) and typically involved the calves (81%). Proximal
cutaneous involvement (thighs 19%/abdomen 9.5%) was less common. Eighteen (86%)
related a history of lower extremity cellulitis/lymphangitis and/or manifested
soft-tissue infection upon presentation. Multisegmental ENV was statistically
more likely in setting of a higher body mass index (P = .02), larger calf
circumference (P = .01), multiple lymphedema risk factors (P = .05), ulcerations
(P < .001), and nodules (P < .001). Calf circumference was significantly and
proportionally linked to developing lower extremity ulcerations (P = .02).
Ulcerations and nodules were significantly prone to occur concomitantly (P =
.05). Nodules appeared more likely to exist in the presence of a higher body mass
index (P = .06) and multiple lymphedema risk factors (P = .06).
LIMITATIONS: The statistical conclusions were potentially inhibited by the
relatively small cohort. The study was retrospective.
CONCLUSIONS: Our data confirm the association among obesity, soft-tissue
infection, and ENV. Chronic venous insufficiency may be an underappreciated risk
factor in the genesis of ENV.
Copyright © 2010 American Academy of Dermatology, Inc. Published by Mosby, Inc.
All rights reserved.
DOI: 10.1016/j.jaad.2010.04.047
PMID: 21440328 [Indexed for MEDLINE]
