Letters to the Editor

6. SCImago 2007. SJR- SCImago Journal and Country Rank. DOI: 10.4103/0378-6323.69038 - PMID: ***** Available from: http://www.scimagojr.com/journalsearch. php?q=24245andtip=sidandclean=0 [last accessed on 2010 REFERENCES May 19]. 1. Thomas M, George R, Thomas M. Linear epidermolytic acanthoma of vulva: An unusual presentation. Indian J Dermatol Venereol Leprol 2010;76:49-51. 2. Adams BB, Mutasim DF. Adult onset verrucous epidermal Linear epidermolytic acanthoma nevus. J Am Acad Dermatol 1999;41:824-6. 3. Kawaguchi H, Takeuchi M, Ono H, Nakajima H. Adult onset or adult-onset verrucous of inflammatory linear verrucous epidermal nevus. J Dermatol 1999;26:599-602. epidermal nevus? 4. Kosann MK. Inflammatory linear verrucous epidermal nevus. Dermatol Online J 2003;9:15.

Sir, Thomas et al. reported a 50-year-old woman who had unilateral, linearly arranged verrucous papules Authors' reply and plaques on the labia majora and on the adjacent perineum and thigh. Biopsy revealed features of Sir, epidermolytic hyperkeratosis. A diagnosis of linear We are grateful to our esteemed colleagues for their epidermolytic acanthoma was made.[1] comments[1] on our article[2] and for the interest shown. Several features of the case closely match the findings of verrucous epidermal nevus of the epidermolytic We would however like to assert that the patient hyperkeratotic type: unilaterality, linear/Blashckoid described by us had an epidermolytic acanthoma of arrangement of papules and the variable degree of the vulva, a well-described entity,[3-5] in a linear pattern verrucosity in the papules and plaques as seen in the rather than an adult-onset verrucous epidermal nevus, clinical image. On the other hand, as indicated by as suggested, for the following reasons: the authors, epidermolytic acanthomas are usually a. The articles cited[6-8] in the letter refer to adult- solitary lesions and, even when multiple, do not have onset verrucous and inflammatory epidermal nevi a unilateral, Blaschkoid distribution. Thomas et al. and not to epidermolytic verrucous epidermal excluded the diagnosis of verrucous epidermal nevus nevus. None of the reported cases had features of because of onset of lesions in adulthood and gradual epidermolytic hyperkeratosis, a distinctive feature progression over the next several years. However, seen on histology in our patient. However, we agree there are reports of adult-onset epidermal nevus in the that the clinical features were indistinguishable literature. Adams and Mutasim described a woman from verrucous and inflammatory linear epidermal who developed a progressive epidermal nevus on the nevi. face at the age of 55 years. They also reviewed five b. Epidermolytic verrucous epidermal nevus usually other publications reporting epidermal nevi that began occurs at birth or in young children.[9,10] in adulthood.[2] Two other reports have been published since then.[3,4] c. The onset in adulthood, the clinical features, site of occurrence and histologic features of the lesion seen Taken together, the clinical and histopathological in our patient were consistent with the diagnosis of [3-5] features appear to be a better fit for the diagnosis epidermolytic acanthoma. The linear pattern of of adult-onset verrucous epidermal nevus of the presentation was unusual and hence the case was epidermolytic hyperkeratotic type than for linear reported in the journal. epidermolytic acanthoma. Molly Thomas, Renu Elizabeth George, M. Ramam Meera Thomas1 Department of Dermatology and Venereology, All India Institute of Departments of Dermatology, Venereology and Leprosy and Medical Sciences, New Delhi - 110 029, India 1Pathology, Christian Medical College and Hospital, Vellore, India

Address for correspondence: Dr. M. Ramam, Address for correspondence: Dr. Renu George, Department of Dermatology and Venereology, All India Institute of Department of Dermatology, Venereology and Leprosy, Christian Medical Sciences, New Delhi - 110 029, India. Medical College and Hospital, Vellore - 632 004, India. E-mail: [email protected] E-mail: [email protected]

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