Perianal verrucous epidermal naevus mimicking perianal warts.

CASE REPORT A 2 year old boy was referred by a paediatrician for the evaluation of a perianal verrucous lesion which looked like perianal warts. The condition was first noticed by the child’s mother when he was 9 months old as a raised velvety area around the anal orifice. Over the next few months, multiple, small, warty elevations developed over the region. The lesions had remained stable thereafter. There was no parental report of scratching, exudations or bleeding, or difficulty in passing stools. There was no history of viral warts or any STD in the parents. The child has remained in good health since his birth and achieved the milestones normally. Examination revealed a mildly elevated, velvety, periorificial skin studded with multiple, brownish, keratotic papules (fig 1). Detailed systemic examination failed to reveal any abnormality. A provisional diagnosis of verrucous epidermal naevus was made and a punch biopsy specimen was obtained. Histological examination corroborated the clinical diagnosis by showing hyperkeratosis, acanthosis, and papillomatosis without any evidence of vacuolar change in the keratinocytes or any dermal pathology. Virological study for human papillomavirus (HPV) could not be done owing to lack of facilities. The parents declined any immediate treatment for the asymptomatic condition and during a follow up period of 1 year, the child has remained healthy with the lesions remaining unchanged in appearance.