Table 2 Features of elephantiasis nostras verrucosa reported in the literature.
| References | Age/ Gender | Physical exam | Medical history | Biology test | Radiology test | Treatment | Evolution |
|---|---|---|---|---|---|---|---|
| Samanci NS, Poturoglu S. Elephantiasis nostras verrucosa. The Indian Journal of Medical Research 2017 June | 41 YO M | - Pain, Bad smell - Deformity - Bilateral swelling on the lower limbs - Edema, plaques - Lichenification - Indurated cobblestone-like papulonodules | - No family history - Diabetes type 2 - Nephropathy - Morbid obesity - Hypertension - Congestive heart failure - Received antibiotic therapy | - Blood test: normal - Sedimentation: 117 mm/h | Lymphoscintigraphy: occlusion of lymphatic channels | - Antibiotic - Furosemide - Elevate legs - Reduce body weight - Resection of the hypertrophied areas | Was lost |
| Mansur AT et al. A case of elephantiasis nostras verrucosa treated successfully by a new type of compressive garment. Dermatol Ther. 2020 | 69 YO M | - Edema, Lymphorrhea - Dusky red color - Multiple verrucous - Brownish-red papulonodules with cobblestone-like - Scattered superficial | - No family history - Diabetes type 2 - Deep venous thrombosis of the right leg | - Blood cell count, thyroid function test, blood biochemistry: Normal - C-reactive protein: 15.07 mg/l | - Venous color-doppler sonography of the right lower extremity: Thrombosis, and subcutaneous edema left lower extremity | -Topical keratolytic -Two-layer bandage twice a week then four-layer bandage then low-stretch compression garment | Verrucous papulonodules regressed almost totally Reduction in edema |
| Santiago L. et al. A Case of exuberant elephantiasis nostras verrucosa. Acta Med Port. 2017 May | 76 YO W | - Heard failure - Chronic venous insufficiency - Secondary lymphedema associated to bilateral cellulitis | - Nonpitting edema - Foul-smelling mossy plaques - Cobblestone-like nodules in both legs | Skin biopsy: Hyperkeratosis of the epidermis with underlying dilated lymphatics | Venous doppler studies: No evidence of deep vein thrombosis | - Leg elevation - Diuretics - Compression - Topical keratolytic - Debridement | Great |
| Duckworth AL et al. Elephantiasis nostras verrucosa or “mossy foot lesions” in lymphedema praecox: report of a case. J Am Podiatr Med Assoc. 2008 Jan–Feb | 32 YO W | - Malodor, no pain - Minor discomfort with certain shoes - Lymphedema - Non pitting edema, no open lesions, no signs of infection on the legs- Lichenification, papules and nodules | Cesarean section | Skin biopsy: Verrucous, hyperkeratosis, papillomatosis Dermis: fibrotic between numerous dilated lymphatic | |||
| Lee EY, Sia CH Visual Dermatology: Elephantiasis Nostras Verrucosa. J Cutan Med Surg. 2021 Mar-Apr | 46 YO M | - Non pitting edema - Hyperkeratosis - Lichenified crusted papillomatous plaques - Cobblestone nodules | Chronic lymphedema - Recurrent cellulitis | Blood filariasis microscopy and serology negative | Scintigraphy: Partial lymphatic obstruction | ||
| Hagen TL. Elephantiasis nostras verrucosa [Elephantiasis nostras verrucosa]. Ugeskr Laeger. 2015 Dec | 76 YO W | - Fever - Hyperkeratotic skin - Hyperpigmentation - Cobblestone nodules - Ulcer, malodor | - Obesity - Chronic venous stasis | C-reactive protein 504 nmol/L | Venous doppler studies: No evidence of deep vein thrombosis, no abscess | - Bath of permanganate of potassium - Debridement - Antibiotic | Bonne evolution |
| Luciano et al. Elephantiasis nostras verrucosa. Journal of Hospital Medicine, 2009, vol. 4, no 7 | 79 YO W | - Afebrile, no adenopathy - Bilateral lower extremity edema - Hyperpigmented - Cobble-stoned - Hyperkeratotic skin - Verrucous nodules on the inner thighs | - Heart failure - Morbid obesity - Chronic lymphedema - Deep vein thrombosis with inferior vena cava filter placement | - Compression stocking - Topical emollients | |||
| Hernandez et al. Elefantiasis verrucosa nostra. Atención Primaria, 2019, vol. 51, no 8, p. 521 | 73 YO M | - Bilateral swelling on the lower limbs - Edema - Papules confluentes - Cobblestones nodules - Sign for Kaposi–Stemmer | - Obesity - Hypertension - Diabetes type 2 - Hypercholesterolemia - Bilateral pulmonary thromboembolism | ||||
| Shah M. et al. Images in clinical medicine. Elephantiasis nostras verrucosa. N Engl J Med. 2014 Jun | 49 YO W | - Extensive areas of redness - Weeping sores on her legs - Hyperkeratosis, ulcer - Papillomatous plaques - Loosely adherent crust - Cobblestone-like nodules | - Morbid obesity - Hypertension - Chronic venous stasis - Lymphedema | Venous doppler studies: No evidence of deep vein thrombosis | - Wound care - Antimicrobial therapy | Improved | |
| Freitas A. et al. Elephantiasis nostras verrucosa secondary to recurrent erysipelas. BMJ Case Rep. 2017 Aug | 79 YO M | - Edema, exophytic - Nausea, Prostration, Fever - Lesions of a mossy and verrucose appearance - Agglomerated lesions | - Several episodes of erysipelas - Chronic venous insufficiency - Diabetes type 2 | - Furosemide - Heparin - Antibiotic | |||
| Hadi Y. et al. Elephantiasis nostras verrucosa: an atypical presentation following intrapelvic lymphoma. Dermatol Online J. 2019 Dec | 72 YO M | - Verrucous - Weeping cysts - Nodules of the bilateral legs - No ulcers | - Edema, Ulceration - Intrapelvi lymphoma, Intrapelvic non hodgkin follicular B cell lymphoma status post-remission with chemotherapy - Hypogammaglobulinemia - Morbid obesity | - Thyroid stimulating hormone: Normal - Serum IgG: Decreased - kidney and liver : Normal | - Echocardiogram: no heart failure - Venous deplex reflux studies displayed superficial cystic lesions consistent with lymphatic ectasia bilaterally and evidence of superficial venous reflux with involving the greated saphenous vein in the right lower leg | - Compressive - Lymphatic pump at home | |
| Pérez-Rodrigez IM et al. Elephantiasis nostras verrucosa as a manifestation of morbid obesity. BMJ Case Rep. 2014 Nov | 48 YO M | - Edema - Hyperpigmentation - Hyperkeratosis - Verrucous aspect | - Morbid obesity - Atrial fibrillation - Abdominoplasty | Skin biopsy: - Hyperkeratosis, Papollomatosis - Proliferation, Dermal fibrosis - Dilatation of blood vessels and lymphatics | Died days after admission from heart complications and sepsis | ||
| Yang YS et al. A case of elephantiasis nostras verrucosa. Ann Dermatol. 2009 Aug | 67 YO M | - Hard papules and plaques on both feet - Confluent brownish verrucous papules and plaques with a moss-covered appearance surrounding the peripheries of both feet | - Habit of drinking rawdeer blood - Hospitalized several times for recurrent cellulitis of both feet - Type 2 diabetes | - Mildly elevated erythrocyte sedimentation rate - Glucose 193 mg/dl - Test for microfilaria resulted in negative findings | - Lower extremity computed tomographic angiography: Varicose veins with early venous drainage at both feet and ankles - Skin biopsy: Hyperkeratosis and pseudoepitheliomatous hyperplasia channels | - Oral etretinate - Topical salicylic acid | - Little improvement after 3 months - Patient refuse any interventions of the venous problem - Lost to follow-up |
| Nwabudike L.C. et al. An integrative therapeutic approach to elephantiasis nostras verrucosa: A case report. Exp Ther Med. 2022 Apr | 72 YO W | - Erythema - Oozing excoriation of the legs with deep fold and creases | - Pedal edema - No history of infections, cardiac, renal, thyroid or hepatic disease | - Anemia - Renal impairment - Hypoalbuminemia | - Furosemide - Apocynum cannabinum | Decrease of the limb diameter Lost to follow-up | |
| Lo Schiavo A. et al. Elephantiasis nostras verrucosa in a patient with obesity and chronic venous insufficiency. Int J Dermatol. 2013 Apr | 62 YO W | - Brown-colored nonpitting edema - Multiple nodular verrucous lesions Cobblestone-like | - No personal history of flariasis or familiar milroy’s disease - Obesity - Venous insufficiency | ||||
| IWao F. et al. Elephantiasis nostras verrucosa successfully treated by surgical debridement. Dermatol Surg. 2004 Jun | 42 YO M | - Verrucous Cobblestone-like lesions - Hyperkeratotic - Malodorous | - Paralysis poliomyelitis - Never suffered from filariasis - No family history of familial lymphedema (milroy’s disease) | Skin biopsy: Hyperkeratosis, acanthosis, fibrosis of the dermis, numerous dilated lymphatic capillaries | - Topical, Dermabrasion - Electrocoagulation - Antiobiotic - Elevated position - Compression stocking | Good | |
| Shimbo K. et al. Hybrid Treatment Combining Lymphaticovenous Anastomoses and the Oriental Herbal Medicine Bofutsushosan for Obesity-Associated Lower Leg Elephantiasis Nostras Verrucosa: A Case Report. Int J Low Extrem Wounds. 2021 Sep | 79 YO W | - Nonpitting edema of both lower legs - Multiple nodular verrucous lesions - Ulceration on the loft foot | - Orthopedic disease - Mobid obesity | - Laboratory test results were normal - Minimal elevation of C-reactive protein | - Ultrasonography and contrast-enhanced computed tomography of the lower extremity: Edema and non venous involvement - Skin biopsy: Hyperkeratosis, acanthosis | - Bofutsushosan - Lymphatico-venous anastomoses - Debridement - Compression stocking - Lost weight | Good |
| Han HH et al. Successful Surgical Treatment for Elephantiasis Nostras Verrucosa Using a New Designed Column Flap. Int J Low Extrem Wounds. 2015 Sep | 51 YO F | - Sign for Kaposi–Stemmer - Verrucous and cobblestone-like lesions | - Omental transposition with superficial lymphangectomy of right leg lymphangitis | Debridement | |||
| Khetarpal A. et al. Elephantiasis nostras verrucosa: a severe complication of lymphoedema. Br J Hosp Med (Lond). 2020 May | 59 YO M | - Hyperkeratotic - Verrucous lesions - Papollomatous plaques | - Compression bandaging - Emollient - Antifungal | Improvement of skin | |||
| Fredman R. et al. Elephantiasis nostras verrucosa. Eplasty. 2012 | 53 YO W | - Fever - Nonpitting - Malodorous - Hyperpigmentation - Cobblestone-like lesions | - Morbid obesity - Recurrent cellulitis - Erysipelas - osteomyelitis | ||||
| Simon L.J. et al. Elefantiasis verrucosa nostras en paciente afectado de trastorno depresivo mayor. SEMERGEN-Medicina de Familia, 2012, vol. 38, no 8, p. 526-529 | 40 YO M | - Venous insufficiency - Major depressive disorder | - Debridement - Conservative measures | ||||
| Damani Z. et al. Elephantiasic Pretibial Myxedema. J Cutan Med Surg. 2022 May–Jun | 68 YO M | - Febrile, hypotention, tachycardia - Swelling - Hyperpigmentation Keratotic papules and plaques - Malodorous | - Atrial fibrillation - Morbi obesity - Heart failure - Venous stasis dermatitis | - Diuretic |
M: man; W: woman; YO: years old