Elephantiasis nostras verrucosa as a manifestation of morbid obesity

A 48-year-old man with morbid obesity was evaluated for atrial fibrillation. He had a history of abdominoplasty and had been bedridden since the procedure. His current weight was 394 kg and his previous weight 567 kg. He presented a chronic disseminated dermatosis on both legs and abdomen, characterised by oedema, hyperpigmentation, hyperkeratosis and a verrucous aspect (figure 1). A skin biopsy showed hyperkeratosis, papillomatosis, proliferation and dilation of blood vessels and lymphatics, dermal fibrosis, haemosiderin deposition and fat lobules separated …