WikiPortallus: Lewandowsky-Lutz dysplasia.html

Epidermodysplasia verruciformis (also called Lewandowsky-Lutz dysplasia or Lutz-Lewandowsky epidermodysplasia verruciformis) is an extremely rare autosomal recessive genetic¹ hereditary skin disorder associated with a high risk of carcinoma of the skin. It is characterized by abnormal susceptibility to human papillomaviruses (HPVs) of the skin.² The resulting uncontrolled HPV infections result in the growth of scaly macules and papules, particularly on the hands and feet. It is typically associated with HPV types 5 and 8,³ which are found in about 80% of the normal population as asymptomatic infections,⁴ although other types may also contribute.³

The condition usually has an onset of between the ages of 1–20,⁵ but can occasionally present in middle-age.⁵ It is named after the physicians who first documented it, Felix Lewandowsky and Wilhelm Lutz.⁶

Genetic cause

The cause of the condition is an inactivating mutation in either the EVER1 or EVER2 genes, which are located on adjacent to one another on chromosome 17.¹ The precise function of these genes is not yet fully understood, but they play a role in regulating the distribution of zinc in the cell nucleus. It has been shown that zinc is a necessary cofactor for many viral proteins, and that the activity of EVER1/EVER2 complex appears to restrict the access of viral proteins to cellular zinc stores, limiting their growth.⁷

Diagnosis

Clinical diagnostic features are lifelong eruption of pityriasis versicolor-like macules, flat wart-like papules and development of cutaneous carcinomas. Patients present with flat, slightly scaly, red-brown macules on the face, neck and body, or verruca-like papillomatous lesions, seborrheic keratosis-like lesions, and pinkish-red plane papules on the hands, upper and lower extremities, and face. The benign form of EV presents with only flat, wart-like lesions over the body, whereas the malignant form shows a higher rate of polymorphic skin lesions and development of multiple cutaneous tumors.

Generally cutaneous lesions are disseminated over the body; however, there are some cases with only a few lesions which are limited to one extremity.⁸⁹

Treatment

A totally effective treatment method against EV has not yet been found. However, several treatments have been suggested, and acitretin 0.5–1 mg/day for 6 months’ duration is the most effective treatment owing to antiproliferative and differentiation-inducing effects. Interferons can also be used effectively together with retinoids. Cimetidine was reported to be effective because of its depressing mitogen-induced lymphocyte proliferation and Regulatory T cell activity features. However, a report by Oliveria et al. showed that cimetidine was ineffective. Hayashi et al. applied topical calcipotriol to a patient with a successful result.

As mentioned, various treatment methods are offered against EV; however, most importantly, education of the patient, early diagnosis and excision of the tumoral lesions take preference to prevent the development of cutaneous tumors.

Notable cases

In March 2007, a Romanian man named Ion Toader was diagnosed with this condition.¹⁰ The man, a patient of dermatologist Carmen Madeleine Curea, quickly became an internet meme, his pictures appearing on numerous blogs and Romanian press sources. Curea works out of Spitalului Clinic Colentina in Bucharest, Romania. Stephen Stone, past president of the American Academy of Dermatology, confirms this is Lewandowsky-Lutz.^{citation needed}

In November 2007, a new video of a 34-year-old Indonesian man, Dede Koswara with a similar disease appeared on the internet.¹¹ His story has appeared in the Discovery Channel and TLC series "My Shocking Story" ("Extraordinary People" on UK's Five) in the episode "Half Man Half Tree".¹² And then on August 12, 2008, Dede Koswara's story was the subject of an ABC's Medical Mystery episode entitled "Tree Man".

On August 26, 2008, MSNBC reported that Dede had returned home following surgery to remove thirteen pounds (5.8 kilo) of warts from his body.¹³ In all, 95% of the warts were removed. ¹³

References

^ ^a ^b Ramoz, N; LA Rueda, B Bouadjar, LS Montoya, G Orth, M Favre (December 2002). "Mutations in two adjacent novel genes are associated with epidermodysplasia verruciformis.". Nature Genetics 32 (4): 579-81. PMID 12426567.
^ Lazarczyk, M; C Pons, JA Mendoza, P Cassonnet, Y Jacob, M Favre (2008-01-21). "Regulation of cellular zinc balance as a potential mechanism of EVER-mediated protection against pathogenesis by cutaneous oncogenic human papillomaviruses". The Journal of Experimental Medicine 205 (1): 35-42. PMID 18158319.
^ ^a ^b Orth, G (1986). "Epidermodysplasia verruciformis: a model for understanding the oncogenicity of human papillomaviruses". Ciba Found Symp 120: 157-74. PMID 3013521.
^ "The ubiquity and impressive skin papillomaviruses suggest a commensalic nature of these viruses". The Journal of Virology 74 (24): 11636–11641. December 2000. PMID 11090162.
^ ^a ^b Clinical aspects of epidermodysplasia verruciformis and review of the literature by Ülker Gül, MD, Arzu Kılıç, MD, Müzeyyen Gönül, MD, Seray Külcü Çakmak, MD, and Seçil Soylu Bayis. International Journal of Dermatology Vol. 46, Issue 10, Page 1069–1072. October 2007.
^ Lewandowsky-Lutz dysplasia: Who Named It?
^ Lazarczyk, M; M Favre (10 September 2008 (ahead of print)). "The role of Zn²⁺ ions in host-virus interactions". The Journal of Virology. PMID 18787005.
^ Lowy DR, Androphy EJ. Warts. In: Freedberg IM, Eisen AZ, Wolff K, et al. 6th edn. New York: Mc Graw-Hill, 2003: 2119–2131.
^ Pereira de Oliveira WR, Carrasco S, Neto CF, et al. Nonspecific cell-mediated immunity in patients with epidermodysplasia verruciformis. J Dermatol 2003; 30: 203–209.
^ WFMU's Beware of the Blog: Missionary encounters extremely bizarre skin condition in Eastern Europe
^ The man who looks like a tree | Metro.co.uk
^ My Shocking Story: Half Man Half Tree. Discovery Channel.
^ ^a ^b Indonesia's 'tree man' home after surgery

Lewandowsky-Lutz dysplasia.html

Contents

Genetic cause

Diagnosis

Treatment

Notable cases

References

Further reading

External links