Differential diagnosis of elephantiasis nostras verrucosa
| DIAGNOSIS | CLINICAL FEATURES |
|---|---|
| Venous stasis dermatitis | Pitting edema, erythematous to brownish pruritic patches with dilated superficial veins over the medial lower leg1–3 |
| Lipedema | Early age of onset; positive family history; typically affects overweight women; abnormal accumulation of subcutaneous fat in lower limbs and buttocks; always symmetric and bilateral; feet not affected1,4,5 |
| Lipodermatosclerosis | Related to venous stasis, hyperpigmentation, and nonpitting edema with subcutaneous fibrosis. Characteristic “inverted wine bottle” appearance: swelling of proximal parts and fibrosis of the distal parts of the lower limbs1,4 |
| Pretibial myxedema | Caused by hyperthyroidism. Mucin accumulation of the dermis resulting in nonpitting edematous papulonodules or plaques over anterior surface of the legs and dorsal aspect of the feet1,4 |
| Filariasis | Infection by the parasite Wuchereria bancrofti. History of travel to an endemic tropical area. Obstruction of lymphatic ducts causes secondary bacterial infection. Localized lymphedema in the lower legs and genitals1,4 |
| Chromoblastomycosis | Chronic fungal infection; fungus is commonly found in soil. Infection through minor trauma of skin. Verrucose papulonodules and plaques. Cultures are positive for fungus4 |
Data from Baird et al,1 Yang et al,2 Guarneri and Vaccaro,3 Sisto and Khachemoune,4 and Kerchner et al.5