78
Volume 2 • Issue 2 • 1000117Madridge J Intern Emerg Med.
ISSN: 2638-1621
Madridge
Journal of Internal and Emergency Medicine
Case Report Open Access
Tree man Syndrome
Manjubala Dash*
Professor, Department of Nursing, Mother Theresa Post Graduate & Research Institute of Health Sciences, India
Article Info
*Corresponding author:
Manjubala Dash
Professor
Department of Nursing
Mother Theresa Post Graduate & Research
Institute of Health Sciences
India
E-mail: manju_narayan@rediffmail.com
Received: August 8, 2018
Accepted: August 20, 2018
Published: August 27, 2018
Citation: Dash M. Tree man syndrome.
Madridge J Intern Emerg Med. 2018; 2(2): 78-79.
doi: 10.18689/mjiem-1000117
Copyright: © 2018 The Author(s). This work
is licensed under a Creative Commons
Attribution 4.0 International License, which
permits unrestricted use, distribution, and
reproduction in any medium, provided the
original work is properly cited.
Published by Madridge Publishers
Abstract
Tree man syndrome is an extremely rare condition more formally known as
Epidermodysplasia Verruciformis. Epidermodysplasia Verruciformis (EV, also called
Lewandowsky–Lutz dysplasia), colloquially known as tree man illness is an extremely
rare autosomal recessive genetic [1] hereditary skin disorder associated with a high risk
of carcinoma of the skin. It is characterized by abnormal susceptibility to human
papillomaviruses (HPVs) of the skin [2]. The resulting uncontrolled HPV infections result
in the growth of scaly macules and papules, particularly on the hands and feet. It is
typically associated with HPV types 5 and 8, [3] which are found in about 80% of the
normal population as asymptomatic infections, [4] although other types may also
contribute [3].
The condition usually has an onset of between the ages of one and 20, [5] but can
occasionally present in middle age [5]. It is named after the physicians who first
documented it, Felix Lewandowsky and Wilhelm Lutz (
de
) [6].
Keywords: Infections; Tree man; Syndrome; Epidermodysplasia; Scaly macules and
papules.
Causes
The cause of the condition is an inactivating PH mutation in either the EVER1 or
EVER2 genes, which are located adjacent to one another on chromosome. These genes
play a role in regulating the distribution of zinc in the cell nuclei. Zinc is a necessary
cofactor for many viral proteins, and the activity of EVER1/EVER2 complex appears to
restrict the access of viral proteins to cellular zinc stores, limiting their growth [7].
Signs and Symptoms
Clinical diagnostic features are lifelong eruptions of pityriasis versicolor-like
macules
,
flat wart-like papules, one to many cutaneous horn-like lesions, and development of
cutaneous carcinomas [8].
Patients present with flat, slightly scaly, red-brown macules on the face, neck, and
body, recurring especially around the penial area, or verruca-like papillomatous lesions,
seborrheic keratosis-like lesions, and pinkish-red plane papules on the hands, upper
and lower extremities, and face. The initial form of EV presents with only flat, wart-like
lesions over the body, whereas the malignant form shows a higher rate of polymorphic
skin lesions and development of multiple cutaneous tumors. Generally, cutaneous
lesions are spread over the body, but some cases have only a few lesions which are
limited to one extremity [9], [10].
Treatment
No curative treatment against EV has been found yet. Several treatments have been
suggested, and
acitretin
0.5–1 mg/day for 6 months’ duration is the most effective
treatment owing to anti proliferative and differentiation-inducing effects.
ISSN: 2638-1621
Madridge Journal of Internal and Emergency Medicine
79
Volume 2 • Issue 2 • 1000117Madridge J Intern Emerg Med.
ISSN: 2638-1621
Interferons can also be used effectively together with
retinoids. Cimetidine was reported to be effective because of its
depressing mitogen-induced lymphocyte proliferation and
regulatory T cell activity features. A report by Oliveira et al.
showed that cimetidine was ineffective. Hayashi et al. applied
topical calcipotriol to a patient with a successful result.
As mentioned, various treatment methods are offered
against EV; however, most importantly, education of the patient,
early diagnosis, and excision of the tumoral lesions take
preference to prevent the development of cutaneous tumors.
Case Report
A young Bangladeshi girl with bark-like growths on her
face could be the first female afflicted by “tree man” syndrome,
doctors studying the rare genetic condition. Sahana Khatun,
10, has growths on her chin, ear and nose, but doctors at
Dhaka’s Medical College hospital are still conducting tests to
establish if she has the unusual skin disorder.
Fewer than half a dozen people worldwide have
epidermodysplasia verruciformis but none so far have been women,
said Samanta Lal Sen, the head of the hospital’s burn and plastic
surgery unit. “We believe she is the first woman,” Sen said.
Sahana Khatun
Abul Bajandar
Huge growths weighing five kilogrammes (11 pounds)
each had consumed the hands of 27-year-old
Abul Bajandar
,
the first recorded Bangladeshi to be suffering from the
disease.
References
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in two adjacent novel genes are associated with epidermodysplasia
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