Introduction:
There are three skin layers: epidermis, dermis (the middle layer of the skin), and hypodermis (the innermost layer of the skin). The epidermis is the outermost layer of the skin. In verrucous nevus, the overgrowth of the epidermis occurs. The epidermis also has different layers, stratum basale (deepest layer), stratum spinosum (between stratum spinosum and stratum granulosum layer), stratum granulosum (between spinosum and lucidum layer), spinosum lucidum (between granulosum and corneum), and lastly stratum corneum (topmost layer of the epidermis). It has many functions, such as keeping the skin hydrated, producing new skin cells, and helps protect the skin from UV (ultraviolet) radiation.
What Is Verrucous or Warty Nevus?
It is a non-cancerous and abnormal skin patch caused due to overgrowth in the epidermal layer of the skin. It is visible at birth and, in some cases, appears later in childhood. The term verrucous or warty is given according to the age at which the affected skin becomes darker, thicker, and has a wart-like (verrucous) appearance. Females are more affected than males. Some people have complications in other body parts like the eyes and brain.
What Are the Causes of Verrucous or Warty Nevus?
The leading cause of this condition is gene mutation. The gene has two copies, one each from the mother and the father. The skin cells are also in a set of two, which contain either the father’s or mother’s genes (mosaicism). From these two skin cells' genes, if one of them is abnormal, it leads to thick hard patches on the skin. It rarely affects more than one person in the family. These abnormal genes are not found in normal skin, which is why the other skin area usually grows.
What Are the Symptoms of Verrucous or Warty Nevus?
The symptoms of this condition include:
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Brown or reddish wart-like nevus.
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A thick patch of skin.
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Itchy skin.
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Inflammation around the affected area.
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Patches appear on the limb, underarms, chest, neck, and fingers.
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The swirled pattern on one or both sides of the body.
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Abnormalities in the nervous system.
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Dry skin].
How Is Verrucous or Warty Nevus Diagnosed?
Firstly a detailed patient’s medical history and clinical examination of the patches are done by a professional. Then, in some cases, a skin biopsy, CT (computed tomography), or MRI (magnetic resonance imaging) can be done. However, it should be noted that imaging techniques are not advisable until the patient has symptoms related to a nervous or skeletal system disorder.
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Skin Biopsy - Depending on the area of the skin that has to be tested, a healthcare professional will make a circle or outline it. Then, local anesthesia is given to the patient on the marked site to numb the area. The skin biopsy can be done in two types. First, shave biopsy, in which a sharp scalpel is used, which cuts the skin tissue and may cause bleeding after collecting the sample. The second is a punch biopsy in which the top layer of fat is cut, and stitches are given to close the wound. Skin biopsy is not always recommended in verrucous nevus, especially in infants.
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Imaging Techniques - CT scans and MRIs can be done to evaluate the brain. CT scan uses specialized machines and computers to see the images of the body. MRI (magnetic resonance imaging) uses high and powerful magnetic waves to get detailed body images. The healthcare expert will ask the patient to lie on the table, which will slide into the machine. The high magnetic waves will take a detailed picture in the computer of the brain, which will help in diagnosing the condition more clearly.
What Are the Treatment Options for Verrucous or Warty Nevus?
There is no permanent treatment for this condition. However, some treatment methods help reduce the effects of the symptoms.
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Surgical Excision - In small warts, surgical excision can be opted for. It can be done for aesthetic reasons, but there are a few chances that scarring will not occur. With the help of a sharp tool, the affected thick patch is excised, and the healing will take one to two weeks.
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Topical Ointment - Topical retinoid ointments such as Calcipotriol and Tacrolimus help relieve the inflammation caused by verrucous nevus. These ointments should be used lifelong to avoid the chances of recurrence.
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Cryotherapy - It is widely used in removing warts. During this procedure, the healthcare expert will use different substances, such as liquid nitrous oxide, liquid nitrogen, or argon gas. In verrucous nevus, external cryotherapy is done. The healthcare expert will apply extreme cold on the affected area and destroy the abnormal tissue or cell. The frozen skin will form a blister and peel off. In small warts, the skin will heal significantly with fewer chances of the scar, but if the wart is big or aggravated, it may leave scarring.
Conclusion:
Verrucous or warty nevus is a benign condition that causes thick brown patches on different body parts. It occurs due to a gene mutation that affects the epidermis layer of the skin, which is the topmost layer. In most cases, warty nevus does not cause any complications. Some treatment options, such as surgical excision, retinoids, and cryotherapy, help reduce the symptoms' effects. However, verrucous or warty nevus needs proper care as there are chances of recurring.
