Acquired Epidermodysplasia Verruciformis: Treatment and Challenges

epidermodysplasia_verruciformis or tree warts
As AEV and genetic EV are distinct disease processes, research can focus on treatments tailored to both states and address the specific risk factors of patients who are immunosuppressed.

Developments in the treatment of acquired epidermodysplasia verruciformis (AEV) have been described in research data published in the British Journal of Dermatology.

AEV refers to the development of EV in patients who are immunocompromised and primarily affects patients with HIV infection or those who have undergone transplantation. Authors of a research letter describe developments in the literature in the 10 years since AEV was first reported. The researchers performed a search of PubMed for peer-reviewed articles on AEV published from 1983 to 2019. The search terms “HIV,” “AIDS,” and “transplant” were used within the PubMed subject headings of “epidermodysplasia verruciformis” and “acquired epidermodysplasia verruciformis.” Articles were assessed for AEV treatment descriptions and AEV lesion clearance rates.

A total of 49 articles were reviewed: 10 regarding AEV in patients with transplants and 39 regarding AEV in patients with HIV infection. Of the patients who received transplants (n=11), only 1 achieved complete resolution of AEV lesions with tazarotene 0.5% cream twice weekly. The researchers noted that of the patients with HIV infection (n=103), only 9 were successfully treated for AEV with minimal side effects. Successful treatment regimens included topical tretinoin, topical imiquimod, topical cidofovir, oral acitretin, or a combination of these regimens. One study of 38 patients with HIV infection reported complete resolution of facial warts in 3 patients with AEV who were treated with glycolic acid 15% lotion.

Related Articles

The treatment of AEV remains challenging, the investigators wrote, particularly in patients with complex underlying disease. AEV must also be understood as distinct from genetic EV in research efforts to identify appropriate treatment. The investigators also noted that genetic susceptibility to EV may predispose certain immunosuppressed individuals to AEV; therefore, the apparent selectivity of AEV warrants further research.

Follow @DermAdvisor


Limmer AL, Wu JH, Doan HQ, Rady PL, Tyring SK. Acquired epidermodysplasia verruciformis: a 10-year anniversary update [published online September 23, 2019]. Br J Dermatol. doi: 10.1111/bjd.18549