Widely Spread Unilateral Inflammatory Linear Verrucous Epidermal Nevus (ILVEN)

Abstract

Inflammatory linear verrucous epidermal nevus (ILVEN) is an epidermal nevus that clinically and histologically mimics linear psoriasis. The pathogenesis of psoriasis has been widely investigated, with recent studies focusing especially on targeting proinflammatory cytokines such as IL-17A, TNFα, IL-23, and IL-12, while little is known about ILVEN. Since the treatment for ILVEN varies widely from the administration of topical ointment for psoriasis to invasive methods such as carbon dioxide gas laser, the differential diagnosis between ILVEN and psoriasis is necessary. In this report, we describe a case of widely spread unilateral ILVEN that clinically and histologically mimicked psoriasis vulgaris and could be diagnosed by immunohistochemical staining focused on the IL-36γ/IL-17A axis.

A case of inflammatory linear verrucous epidermal nevus successfully treated with Brodalumab

“…13 Tanita et al reported a case of wide-spread unilateral ILVEN that clinically and histologically mimicked psoriasis vulgaris but was distinguishable by immunohistochemical staining focused on the IL-36γ/IL-17a axis. 21 They showed that while lesional skin of both entities possessed IL-36R cells, the expression of IL-36γ was decreased on the epidermal keratinocytes in ILVEN compared with that in psoriasis lesions. The tendency of both IL-17-producing cells and IL-17R expression was similar in the two groups.…”

“…They showed that while lesional skin of both entities possessed IL‐36R cells, the expression of IL‐36γ was decreased on the epidermal keratinocytes in ILVEN compared with that in psoriasis lesions. The tendency of both IL‐17‐producing cells and IL‐17R expression was similar in the two groups 21 . With similar IL‐17 receptor expression among epidermal keratinocytes of both ILVEN and psoriasis 21 and knowing IL‐17 receptor blockers are an effective treatment in psoriasis vulgaris, 22 it was conceivable that such a biologic agent would be suitable for ILVEN treatment.…”

“…There are at least two case reports of patients presenting with overlapping features of ILVEN and linear psoriasis that responded to treatments with a TNF‐ inhibitor, etanercept, 20 and IL‐17a inhibitor, ixekizumab 13 . Tanita et al reported a case of wide‐spread unilateral ILVEN that clinically and histologically mimicked psoriasis vulgaris but was distinguishable by immunohistochemical staining focused on the IL‐36γ/IL‐17a axis 21 . They showed that while lesional skin of both entities possessed IL‐36R cells, the expression of IL‐36γ was decreased on the epidermal keratinocytes in ILVEN compared with that in psoriasis lesions.…”

“…The tendency of both IL-17-producing cells and IL-17R expression was similar in the two groups. 21 With similar IL-17 receptor expression among epidermal keratinocytes of both ILVEN and psoriasis 21 and knowing IL-17 receptor blockers are an effective treatment in psoriasis vulgaris, 22 it was conceivable that such a biologic agent would be suitable for ILVEN treatment.…”

Spectacular Inflammatory Linear Verrucous Epidermal Nevus (ILVEN)

“…Distinction with linear psoriasis can be difficult histologically. Retinoids and local corticosteroids are not very effective, surgical excision is sometimes practiced and CO2 laser finds its place in this indication with satisfactory results [1][2][3].…”