Case Report: Epidermodysplasia verruciformis misdiagnosed as pityriasis alba in a child: a diagnostic pitfall in facial hypopigmented lesions.

OBJECTIVE

Epidermodysplasia verruciformis (EV) is a rare genodermatosis with susceptibility to specific HPVs and risk of malignant transformation. Atypical EV presenting as isolated facial hypopigmented macules closely mimicking pityriasis alba can lead to misdiagnosis. This case report aims to clarify key differential diagnostic points through a misdiagnosed pediatric case.

METHODS

Clinical data of an 11-year-old girl with EV, initially misdiagnosed as pityriasis alba and confirmed by dermoscopy and histopathology, were retrospectively analyzed. Clinical, dermoscopic, and histopathological distinctions were identified, and early diagnosis and treatment strategies were discussed.

RESULTS

The patient presented with a 6-month history of asymptomatic, progressively enlarging hypopigmented macules on the forehead. Prior treatment for pityriasis alba was ineffective. Dermoscopy revealed irregular pale white papular structures on a pale yellowish-brown background without scale. Histopathology showed characteristic gray-blue, vacuolated epidermal cells, confirming EV. Treatment with topical 5% imiquimod and cryotherapy led to partial regression at 12 weeks, with no new lesions or adverse effects.

CONCLUSION

Atypical EV with isolated facial hypopigmented macules in children is easily misdiagnosed as pityriasis alba. For refractory, progressively enlarging lesions, dermoscopic screening, with histopathological confirmation reserved for equivocal cases, facilitates early diagnosis. The three-tier diagnostic system integrating clinical, dermoscopic, and histopathological evaluation improves early diagnostic accuracy and reduces long-term malignant risk.