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疣状痣（verrucous nevus）属于一种先天性表皮疣状增生，也称表皮痣、线状表皮痣等，一般在初生时或幼儿期发病，但也有10～20岁才出现，男女均可发病。 
面颈部疣状痣临床上通常表现为淡黄色至棕黑色疣体损害。其大小、形态及分布各有不同，大多呈乳头状隆起，排列成带状或线状或斑片状，全身各处均可发生，发生在男女生殖器和肛门及其周围者，往往容易误诊为尖锐湿疣。 
乳晕疣状痣鉴别要点：疣状痣常单侧发生，排列成线状，质较硬，损害表面较干净，不易出血。除一些特殊部位外，他处也往往有同样皮疹。病史较长，外用药物疗效差。
病理改变：表皮呈不同程度的增生，主要是角化过度、乳头瘤样增生以及棘层肥厚，基底层黑色素增多，无尖锐湿疣的空泡化细胞，病理鉴别较容易。 
组织病理学表现治疗：可采用激光、手术或局涂免疫调节剂（钙泊三醇calcipotriol、他克莫司tacrolimus 和 醋酸氟轻松fluocinonide）。
1.激光治疗：将表面乳头状突起的疣状痣彻底气化，观察半年～1年时间，如果复发，可以用改扩术治疗。因为疣状痣的起始部位在皮肤的基底层，激光治疗过浅不易去除，过深易造成瘢痕。
2.冷冻治疗：原理同激光，但极易导致色素脱失。
3.手术切除，小面积病变可手术切除，直接拉拢缝合，但大面积病变一次往往不能彻底切除，可采用改扩术。
Epidermal Naevus This is thought to be a variant form of sebaceous naevus (naevus sebaceous) and is a hamartomatous tumour characterised by hyperplasia of the epidermis and/or its associated components. They may present in a variety of forms – Becker´s naevus, verrucous epidermal naevus, inflammatory linear verrucous epidermal naevus, naevus comedonicus, eccrine naevus, apocrine naevus and white sponge naevus. They are classified according to clinical morphology, site and extent of involvement, and the predominating epidermal structure within the individual lesion.1
Their most common forms are probably the sebaceous naevus affecting the scalp, and the verrucous epidermal naevus which has the appearance of verrucous papules that coalesce to form well-demarcated papillomata, ranging in colour from that of the surrounding skin to much more deeply pigmented. They may be congenital lesions or develop during the early years of life. They tend to grow during childhood and then stabilise during the teenage years.1 They may be localised to a small area or occur in more diffuse forms. They are often arranged in a linear fashion along skin tension lines or the lines of Blashcko (purported lines of epidermal growth derived from clonal tissue patterns thought to be formed in embryo).2 If there are extensive epidermal naevi then they can be associated with extra-dermal abnormalities as part of the epidermal naevus syndrome.
They have the potential to have benign appendigeal tumours arise within them (often syringocystadenoma papilliferum), or to transform into malignant tumours such as basal cell carcinoma or squamous cell carcinoma. The lifetime risk of malignant transformation in sebaceous naevi is quoted at 5–22%,3 but more recent prospective analyses suggest this figure may be significantly lower.4 Verrucous epidermal naevi seem to have a much lower chance of forming tumours.1 Malignant transformation of the lesion is rare before adolescence/adulthood. Visual Appearance
Epidemiology Estimated prevalence in newborns for sebaceous naevus is 0.3%. Epidermal naevus probably has a similar or lower prevalence.4 Presentation The lesions are usually noted at birth or shortly thereafter. They are often pigmented but can be the same as surrounding skin. They are often unilateral, linear and tend to follow Blaschko´s lines.2 May grow and become wart-like during childhood and tend to stabilise during adolescence (in contrast to sebaceous naevi that tend to become hyperplastic in response to sex hormones during adolescence). Differential Diagnosis Sebaceous naevus Nevus syringocystadenomatosus papilliferus Juvenile xanthogranulomata Solitary mastocytoma Multiple melanocytic naevi. Associated Diseases Epidermal naevus syndrome (Jadassohn naevus phakomatosis). This is the presence of multiple or large epidermal naevi associated with disorders affecting the central nervous system, bones and the eye. There are multiple variant syndromes.5 Problems that may arise include: Epilepsy Mental retardation Neurological deficits Vitamin-D-resistant rickets Spina bifida Hyperplastic bone growth Ptosis Nystagmus Optic nerve defects Occulomotor dysfunction. Investigations None are required if the diagnosis is certain and the lesion has not changed appreciably. If there is doubt as to the nature of the lesion or it has recently developed changes that may signify the presence of benign or malignant tumours, then biopsy should be carried out. If there are extensive epidermal naevi then referral/investigations such as neuroimaging, to detect the presence of an epidermal naevus syndrome, should be considered. Management There is no treatment required as such, other than reassurance that they are, on the whole, a benign problem. If there is poor cosmetic appearance then consider dermatological/plastic surgical referral for advice on surgical excision or laser ablation. If the naevus is extremely warty or chronically inflamed (as some forms are) then topical immunomodulatory agents such as calcipotriol, tacrolimus and fluocinonide may be helpful.6 Complications Poor cosmetic appearance Inflammation of the lesion in certain forms (inflammatory linear verrucous epidermal naevus) Benign or malignant tumours arising within the lesion. Prognosis Very good Low risk of benign or malignant tumours arising from the lesion. Document References Dosik J, Epidermal Nevus, Dermatology Online Journal 7(1):14, 2001.; Good, concise clinical overview with images.
Whonamedit.com, Blaschko´s Lines.; Biographical and clinical summary.
Dunkin CS, Abouzeid M, Sarangapani K; Malignant transformation in congenital sebaceous naevi in childhood. J R Coll Surg Edinb. 2001 Oct;46(5):303-6. [abstract]
Al Hammadi A, Lebwohl M, eMedicine, Nevus Sebaceous, 2006.; Good images.
Sugarman JL; Epidermal nevus syndromes.; Semin Cutan Med Surg. 2004 Jun;23(2):145-57. [abstract]
Mutasim DF; Successful treatment of inflammatory linear verrucous epidermal nevus with tacrolimus and fluocinonide. J Cutan Med Surg. 2006 Jan-Feb;10(1):45-7. [abstract]
Internet and Further Reading Naevus (epidermal) (GPN)
Schwartz R, Jozwiak S, eMedicine, Epidermal Nevus Syndrome, 2006.
DermNetNZ, Epidermal Naevi.; Clinical information and good images (including mapping of Blaschko´s lines).
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