Pseudo-epitheliomatous Hyperplasia and Skin Infections

The histological pattern of pseudo-epitheliomatous hyperplasia (PEH) may be encountered in a large series of verruciform/crateriform skin lesions (VC) with or without central ulceration/crusting. Beside neoplastic and inflammatory processes, this clinico-histological pattern may be associated with an extensive range of infectious agents.

A literature search was performed to identify viral, bacterial, fungal, and parasitic mucocutaneous infections potentially presenting with a clinical/histological VC-PEH pattern.

A VC-PEH pattern was reported in parasitic (n=5), viral (n=6), bacterial (n=10), and fungal (n=12) mucocutaneous infections. The infection-linked VC-PEH pattern was typically linked to longstanding mucocutaneous processes. The human papillomavirus (HPV) family, Epstein-Barr virus, poxvirus, and polyomavirus-linked VC-PEH patterns seem to act as direct triggers of keratinocytic hyperproliferation whereas the VC-PEH patterns observed during other viral, parasitic, bacterial and fungal infections probably represent a reactive pattern of the epidermis to chronic mucocutaneous infections. The VC-PEH pattern was also more frequently reported in immunocompromised compared to immunocompetent patients. The risk of the development of a cutaneous squamous cell carcinoma in chronic VC-PEH should not be overlooked.

In the event of longstanding, slowly progressing, isolated, or more profuse VC-PEH skin lesions, a thorough search for infectious agents should be considered, particularly in the immunocompromised patient.