Successful treatment of inflammatory linear verrucous epidermal nevus with tacrolimus and fluocinonide

Background: Inflammatory linear verrucous epidermal nevus (ILVEN) is a relatively rare disorder that is characterized by an early age at onset; severely pruritic linear papules and plaques; histologic features resembling spongiotic dermatitis, psoriasis, or lichenified dermatitis; and poor response to treatment. Objective: To report the successful treatment of ILVEN with potent topical steroid and tacrolimus ointments. Methods: An 11-year-old girl presented with a 1-year history of markedly pruritic, progressive linear eruption that extended from the right foot to the right buttock. She had failed treatment with pimecrolimus, calcipotriol, mometasone furoate, triamcinolone, tazarotene, and alpha-hydroxy acid. Histologic examination revealed the findings of spongiotic dermatitis. Results: The lesions resolved with fluocinonide ointment and tacrolimus 0.1% ointment. Conclusion: The combination of two therapeutic agents with different mechanisms of action likely resulted in the successful treatment of this usually resistant condition.