History:

        A middle-aged man presented with widespread, asymptomatic, indolent wart-like lesions involved the face, dorsa of the hands and trunk in addition to hypopigmented-pinkish flat scaly lesions resembled pityriasis versicolor on the upper back. The condition started since early childhood and the patient has negative family history of similar condition.   

      Epidermodysplasia verruciformis or also known as Lewandowsky–Lutz disease is a rare chronic HPV infection with specific autosomal recessive immune defect. The patients are infected by a series of different HPV types, some of which are carcinogenic. In childhood patients develop multiple warts and large flat lesions resembling tinea versicolor, with no tendency to spontaneous regression. Later Bowen disease and SCC, primarily in sun-exposed skin. Diagnostic approach: Clinical findings; HPV typing and genetic studies essential. The main differential diagnosis is widespread warts in immunosuppressed individuals, such as posttransplantation or HIV/AIDS. Careful monitoring and compulsive use of sunscreens are recommended and both imiquimod and topical 5-FU may be helpful. Systemic retinoids for prophylaxis may be useful.