inflammatory linear verrucous epidermal nevus ( ilven ) is a pruritic , erythematous scaly epidermal nevus which follows the blaschko s lines . various treatment modalities including topical agents , dermabrasion , cryotherapy , laser therapy , and partial - thickness excision has been tried . giant ilven is a relative contraindication to surgical excision and recurrence may be a problem . inflammatory linear verrucous epidermal nevus ( ilven ) is an epidermal nevus presenting with pruritus , erythema , and scaling that occur as linear bands along the lines of blaschko . patients having giant ilven seek treatment due to cosmetic disfigurement . reported therapeutic approaches include topical agents , dermabrasion , cryotherapy , laser therapy , and partial - thickness excision . giant ilven is a relative contraindication to surgical excision and recurrence may be a problem . we report the effectiveness of full thickness excision and skin grafting for the definitive treatment of a giant ilven . a 17 year old female presented with a linear pruritic lesion extending from lateral border of right foot to right gluteal region [ figure 1 ] . the parents noticed that lesion in the second month of life , which continued to grow up to puberty . since last 2 years it was stable . she was prescribed oral , topical and intralesional steroid , isotretinoin and methotrexate in past , without any improvement . linear pruritic lesion extending from lateral border of right foot to right gluteal region at presentation histopathology showed hyperkeratosis with alternate parakeratosis and orthokeratosis and hypergranulosis beneath the orthokeratotic area . there was mild spongiosis with psoriasiform epidermal hyperplasia and mild to moderate perivascular lymphocytic infiltrate in superficial dermis [ figure 2 ] . photomicrograph showing hyperkeratosis with alternate parakeratosis and orthokeratosis and hypergranulosis beneath the orthokeratotic area ( h and e , 10 ) a diagnosis of ilven was made on the basis of intense pruritus , histopathological findings and lack of response to antipsoriatic treatments . considering the marriageable age , posteriorly placed lesion and malignant potential , she had underwent full thickness excision followed by split thickness skin grafting . she was followed up for one year without any recurrence or significant scarring [ figure 3 ] . absent involucrin expression in the parakeratotic epidermis has been reported , a finding that appears to distinguish ilven from psoriasis . about 75% appear during the first five years of life , most often in the first six months , although later onset has been recorded . ilven can be of any length , occasionally extending the whole length of a limb . although generally persistent and resistant to treatment , some lesions have been reported to resolve spontaneously . lichen striatus , linear darier disease , linear porokeratosis , linear lichen planus , linear psoriasis , and the verrucous stage of incontinentia pigmenti may all have similar clinical presentations as the linear verrucous epidermal nevus . ilven can be distinguished from true nevoid psoriasis by pruritus and lack of response to antipsoriatic treatments . lichen striatus is distinguished by its rapid development , generally after the first year of life , by its relative lack of pruritus , by its more lichenoid clinical and histological features , and , eventually , by its spontaneous involution . potent topical corticosteroids applied under occlusion , or intralesional steroid injections , provide little more than temporary symptomatic relief . laser ablation , electrofulguration , cryotherapy , and medium to full - depth chemical peels are other alternatives for smaller lesions . earlier reports say , surgical excision tends to be followed by rapid recurrence unless a generous depth of underlying dermis is removed . our patient had an extensive lesion extending from right foot to gluteal region and did nt respond to any form of medical treatment . the cosmetic results after full thickness excision and skin grafting in our case was excellent without any recurrence within one year of follow up . in conclusion , full thickness excision and skin grafting is a good therapeutic alternative for extensive ilvens and those not responding to medical treatments . our patient had an extensive lesion extending from right foot to gluteal region and did nt respond to any form of medical treatment . the cosmetic results after full thickness excision and skin grafting in our case was excellent without any recurrence within one year of follow up .
inflammatory linear verrucous epidermal nevus ( ilven ) is a pruritic , erythematous scaly epidermal nevus which follows a blaschko 's lines . 
 lichen striatus , linear darier disease , linear porokeratosis , linear lichen planus , linear psoriasis , and the verrucous stage of incontinentia pigmenti may all have similar clinical presentations as the linear verrucous epidermal nevus . 
 ilven can be distinguished from true nevoid psoriasis by pruritus and lack of response to antipsoriatic treatments . 
 various therapeutic modalities have been described , but no one therapy has been successful consistently . though giant ilven is a relative contraindication to surgical excision , here we report a case showing effectiveness of full thickness excision and skin grafting for this condition .