Author(s) Dean SM, Zirwas MJ, Horst AV, et al.

Journal Journal of the American Academy of Dermatology. Date of publication 2011 Jun 1;volume 64(6):1104-10.

Abstract 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]

Source ID (e.g. PMID): 21440328