What are the signs and symptoms of elephantiasis nostra verrucosa (ENV) in patients with lymphedema?

Updated: Mar 24, 2021
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: William D James, MD  more...
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With long-term involvement, elephantiasis nostra verrucosa (ENV) develops, which is an area of cobble-stoned, hyperkeratotic, papillomatous plaques most commonly seen on the shins. The plaques of ENV can be covered with a loosely adherent crust, can be weepy or oozing a clear or yellow fluid, and/or can have a foul-smelling odor.

Fissuring, ulcerations, skin breakdown, and lymphorrhea can also be seen. Lymphorrhea involves the weeping or oozing of clear, yellow, or straw-colored fluids. Superinfection is common and can manifest as impetigo with yellow crusts.

In as study comparing arm and leg edema, it was found that leg lymphedema has worse symptoms and a greater number of infections than arm lymphedema. [54]

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