title: Elephantiasis nostras verrucosa: an institutional analysis of 21 cases.
abstract: BACKGROUND
  Previous reports regarding elephantiasis nostras verrucosa (ENV) have been typically limited to 3 or fewer patients.
  
  
  OBJECTIVE
  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).
  
  
  CONCLUSIONS
  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.
authors: Department of Cardiovascular Medicine, Ohio State University College of Medicine, Columbus, Ohio 43210, USA. steven.dean@osumc.edu
authors: Steven M
authors: SM
authors: Dean
authors: Matthew J
authors: MJ
authors: Zirwas
authors: Anthony Vander
authors: AV
authors: Horst
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D002908:Chronic Disease; D015897:Comorbidity; D003872:Dermatitis / Q000453:epidemiology; D004604:Elephantiasis / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology*; D009767:Obesity, Morbid / Q000453:epidemiology; D012189:Retrospective Studies; D012594:Scleroderma, Localized / Q000453:epidemiology; D012883:Skin Ulcer / Q000453:epidemiology; D018461:Soft Tissue Infections / Q000453:epidemiology; D014689:Venous Insufficiency / Q000453:epidemiology