Lymphostatic verrucosis

A 32-year-old male patient presented with recurrent episodes of fever, redness, and painful edema of the right leg and pain over the right inguinal region of 20 years duration with edema persisting in between exacerbations. On examination, there was non-pitting pedal edema predominantly over the dorsum of the right foot. Dermatological examination revealed multiple discrete and pedunculated papules and plaques with verrucous surface over the dorsal [Figure 1] and the lateral [Figure 2] aspects of the right foot and 2^nd to 4^th toes. Kaposi-stemmer sign was positive.

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Figure 1:

Verrucous papules and plaques of lymphostatic verrucosis over the dorsal aspect of the right foot and 2^nd to 4^th toes.

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Figure 2:

Pedunculated verrucous plaques of lymphostatic verrucosis on the lateral aspect of the right foot.

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Lymphostatic verrucosis, also known as elephantiasis nostras verrucosa, is a rare form of chronic lymphoedema that causes progressive cutaneous hypertrophy leading to severe disfigurement of body parts (especially of lower limbs) with gravity dependent blood flow.