Elephantiasis nostras verrucosa: An institutional analysis of 21 cases

BackgroundPrevious reports regarding elephantiasis nostras verrucosa (ENV) have been typically limited to 3 or fewer patients.ObjectivesWe sought to statistically ascertain what demographic features and clinical variables are associated with ENV.MethodsA retrospective chart review of 21 patients with ENV from 2006 to 2008 was performed and statistically analyzed.ResultsAll 21 patients were obese (morbid obesity in 91%) with a mean body mass index of 55.8. The average maximal calf circumference was 63.7 cm. Concurrent chronic venous insufficiency was identified in 15 patients (71%). ENV was predominantly bilateral (86%) and typically involved the calves (81%). Proximal cutaneous involvement (thighs 19%/abdomen 9.5%) was less common. Eighteen (86%) related a history of lower extremity cellulitis/lymphangitis and/or manifested soft-tissue infection upon presentation. Multisegmental ENV was statistically more likely in setting of a higher body mass index (P = .02), larger calf circumference (P = .01), multiple lymphedema risk factors (P = .05), ulcerations (P < .001), and nodules (P < .001). Calf circumference was significantly and proportionally linked to developing lower extremity ulcerations (P = .02). Ulcerations and nodules were significantly prone to occur concomitantly (P = .05). Nodules appeared more likely to exist in the presence of a higher body mass index (P = .06) and multiple lymphedema risk factors (P = .06).LimitationsThe statistical conclusions were potentially inhibited by the relatively small cohort. The study was retrospective.ConclusionsOur data confirm the association among obesity, soft-tissue infection, and ENV. Chronic venous insufficiency may be an underappreciated risk factor in the genesis of ENV.