Human papillomavirus type 5 related epidermodysplasia verruciformis in a patient with systemic lupus erythematosus - Report of two cases and review of the literature

Epidermodysplasia verruciformis (EV) is a rare cutaneous human papilomavirus (HPV) infection characterized by an unusual susceptibility to a specific group of HPVs, so-called epidermodysplasia verruciformis associated human papillomaviruses (EV-HPVs). We herein report a 42-year-old women with a history of systemic lupus erythematosus (SLE) who initially showed multiple erythematous flattopped papules on the neck and medial forearms and progressively developed numerous brownish macules on her face, neck, upper chest and back in the following three years. The histopathology revealed characteristic viral cytopathic changes in an acanthotic epidermis: multifocal enlarged keratinocytes with cytoplasmic vacuolization in granular layer and upper spinous layer. The diagnosis of EV was thus made. Besides, the presence of human papillomavirus type 5 (HPV 5) DNA was detected on the lesional and peri-lesional skin. The patient was then treated with different modalities including Erbium-YAG laser, cryotherapy with liquid nitrogen, and topical 5% imiquimod. Partial clearing of the lesions were observed by all these three modalities up to a 6-month period of follow-up. In addition, we make a review of the relationship between EV, EV-HPV and development of non-melanoma skin cancers (NMSCs).