| Introduction: Epidermodysplasia Verruciformis (EV) is a rare autosomal recessive genodermatosis caused by HPV types 5 and 8, typically manifesting in childhood. Clinically, it mimics conditions like pityriasis versicolor or seborrheic keratoses, but carries a significant risk of malignant transformation. Management is challenging, especially in atypical presentations in adulthood. Case Report: A 50-year-old male presented with asymptomatic hyperpigmented, verrucous lesions over the forehead, eyebrow, and preauricular region since childhood, with a positive family history. Clinical differentials included seborrheic and actinic keratoses. Histopathology revealed features consistent with EV, including koilocytosis and focal squamous proliferation without atypia. Initial therapy with Acitretin titrated upto 20mg daily showed limited improvement. A therapeutic shift to combined cryotherapy and radiofrequency ablation in alternate sessions (9 each) resulted in visible reduction in lesion size and number, without post-procedural scarring. Discussion: EV poses both diagnostic and therapeutic challenges, especially in adults with atypical presentations. Cryotherapy was utilized to achieve rapid lesion debulking through localized tissue necrosis, while alternating radiofrequency ablation enabled precise and efficient removal of the residual lesion, optimizing therapeutic efficacy. Conclusion: Though no definitive cure exists, cryotherapy and radiofrequency provide cost-effective, cosmetically favorable results while minimizing psychosocial impact. Importantly, early intervention is vital given the 30–60% risk of malignant transformation. Our case highlights the practical utility of combined physical modalities in managing EV, especially when pharmacological options fall short. |
