By Gary M. White, MD

Elephantiasis nostras verrucosa

Elephantiasis nostras verrucosa is the mossy, pebbly thickening of the skin, usually the lower legs, as a result of chronic edema.


A chronically enlarged, edematous leg or legs with a verrucous or cobblestoned surface is characteristic. This condition is most common on the lower legs, but rarely, the back, buttocks, ears, and pannus have been affected. Skin affected by elephantiasis nostras verrucosa (ENV) can serve as a nidus for infection. Recurrent cellulitis may be seen.


Controlling the edema as best as possible is paramount. Elevation of the legs, support hose, and weight loss are recommended. Antibiotics for infection may be needed. A high-potency topical steroid may decrease the pebbly thickening. Acitretin may be considered. Surgical debridement has been recommended if the primary cause can be controlled.

Additional Pictures

Elephantiasis nostras verrucosa

Elephantiasis nostras verrucosa Elephantiasis nostras verrucosa


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