Elephantiasis nostras verrucosa.
Elephantiasis nostras verrucosa (ENV) is a rare form of chronic lymphedema that causes progressive cutaneous hypertrophy. It can lead to severe disfiguration of body parts with gravity-dependent blood flow, especially the lower extremities. Various factors can cause obstruction of the lymphatic system and result in ENV. Clinically, ENV is characterized by nonpitting edema and superimposed hyperkeratotic papulonodules with a verrucose or cobblestone-like appearance and additional leg ulcers as seen in this case. If the disease is not treated, it eventually results in pain and immobility. Although elephantiasis nostras resembles the elephantiasis caused by helminths, it is not a filarial disease. Instead, it is a complication of chronic lymphedema. Both elephantiasis nostras and filarial elephantiasis are characterized by impaired lymphatic drainage, which results in excess fluid accumulation. In the management of ENV, it is crucial to treat the underlying causes. Lymphostasis can be managed conservatively using medical bandages, compression stockings, and mechanical massages. Elastic bandage compression is reported to be an effective treatment. Diuretics and systemic antibiotics might be needed to reduce edema and control infection. In addition, hyperkeratotic plaques can be treated with topical keratolytics or systemic retinoids.
