Epidermodysplasia verruciformis (EV) , also known as tree man syndrome , is a particularly rare inherited skin disorder of the skin that is associated with a high risk of skin cancer. It is characterized by unusual susceptibility to human papillomaviruses (HPV) of the skin. Uncontrolled HPV infection leads to the development of scabs, especially on the hands and feet. It is commonly associated with HPV types 5 and 8, which are found in approximately 80% of the normal population as an asymptomatic infection.

This condition usually begins between the ages of one and 20 but can sometimes appear in middle age. The condition is also known as Lewandowsky-Lutz dyslasia – named after the doctors who first documented the syndrome, Felix Lewandowsky and Wilhelm Lutz.

The clinically diagnostic features of tree man syndrome are the sequential and lifelong appearance of black scab-like streaks, wart-like pimples, one or even more horn-like lesions in the skin, and the development of skin carcinoma. Patients have flat, slightly scaly, red-brown streaks on the face, neck, and body, especially around the lobar area, or papillomatous verruca-like lesions, verruca-like lesions, and red pimples on the hands, upper and lower limbs, face. The initial manifestations of EV are only flat, warty lesions on the body, whereas malignant formations have shown a higher incidence of pleomorphic skin lesions and the development of multiple masses. Ouch. In general, skin damage is widespread throughout the body, but in some cases there are only a few lesions limited to one part.

The cause of this condition is an inactivating PH mutation in the EVER1 or EVER2 genes, located close together on chromosome 17. These genes play a role in regulating zinc distribution in the cell nucleus. Zinc is an essential cofactor for many viral proteins. The activity of the EVER1/EVER2 complex appears to limit the access of viral proteins to cellular zinc sources, limiting their growth. ^[5] Other genes are also rarely associated with this condition.

No curative treatment against EV has yet been found. Several treatments have been proposed, with acitretin 0.5–1 mg/day for a period of 6 months considered the most effective treatment. Interferon can also be used effectively with retinoids. Cimetidine has been reported to be effective because of its mitogen-induced lymphocyte proliferation and T regulatory cell activation features. A report by Oliveira et al. showed that cimetidine was not effective. Hayashi et al. Topical application of calcipotriol to patients had successful results. As mentioned, different treatments are offered to combat EVs; However, most importantly, patient understanding, early diagnosis, and removal of tumor lesions are considered the priority solutions to prevent the development of skin tumors.