Elephantiasis nostras verrucosa: an institutional analysis of 21 cases

J Am Acad Dermatol. 2011 Jun;64(6):1104-10. doi: 10.1016/j.jaad.2010.04.047. Epub 2011 Mar 25.


Background: Previous reports regarding elephantiasis nostras verrucosa (ENV) have been typically limited to 3 or fewer patients.

Objectives: We sought to statistically ascertain what demographic features and clinical variables are associated with ENV.

Methods: A retrospective chart review of 21 patients with ENV from 2006 to 2008 was performed and statistically analyzed.

Results: All 21 patients were obese (morbid obesity in 91%) with a mean body mass index of 55.8. The average maximal calf circumference was 63.7 cm. Concurrent chronic venous insufficiency was identified in 15 patients (71%). ENV was predominantly bilateral (86%) and typically involved the calves (81%). Proximal cutaneous involvement (thighs 19%/abdomen 9.5%) was less common. Eighteen (86%) related a history of lower extremity cellulitis/lymphangitis and/or manifested soft-tissue infection upon presentation. Multisegmental ENV was statistically more likely in setting of a higher body mass index (P = .02), larger calf circumference (P = .01), multiple lymphedema risk factors (P = .05), ulcerations (P < .001), and nodules (P < .001). Calf circumference was significantly and proportionally linked to developing lower extremity ulcerations (P = .02). Ulcerations and nodules were significantly prone to occur concomitantly (P = .05). Nodules appeared more likely to exist in the presence of a higher body mass index (P = .06) and multiple lymphedema risk factors (P = .06).

Limitations: The statistical conclusions were potentially inhibited by the relatively small cohort. The study was retrospective.

Conclusions: Our data confirm the association among obesity, soft-tissue infection, and ENV. Chronic venous insufficiency may be an underappreciated risk factor in the genesis of ENV.

MeSH terms

  • Adult
  • Aged
  • Body Mass Index
  • Chronic Disease
  • Comorbidity
  • Dermatitis / epidemiology
  • Elephantiasis / epidemiology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Obesity / epidemiology*
  • Obesity, Morbid / epidemiology
  • Retrospective Studies
  • Scleroderma, Localized / epidemiology
  • Skin Ulcer / epidemiology
  • Soft Tissue Infections / epidemiology
  • Venous Insufficiency / epidemiology

Supplementary concepts

  • Lipodermatosclerosis