Tree Man Syndrome: Cause, Treatment, Cure, Prevention

Tree Man Syndrome is a skin condition that causes tree bark-like lesions to grow uncontrollably on the hands and feet.

People have heard of this syndrome from the news on patients like Dede Koswara, Ion Toader, and Abul Bajandar.

Tree Man Syndrome
Abul Bajandar from Bangladesh and his worsening EV lesions.

What Is Tree Man Syndrome?

The scientific name for Tree Man Syndrome is Epidermodysplasia verruciformis (EV) and is also known as Lewandowsky-Lutz dysplasia.  It is a rare autosomal recessive hereditary skin disorder (1).

The skin condition most commonly affects people between the ages of 1-20 (2).

It is caused because of the patient’s skin is abnormal susceptibility to the human papillomaviruses (HPVs) (3).

When the patients are infected with HPV, uncontrollable growths of papules and scaly macules occur, mostly in the arms and legs. According to scientific studies on the condition, the HPV types 5 and 8 are associated with the tree bark lesions (4).

In addition to the tree bark-like lesions, skin disorder can also put the patient at a high risk of skin cancer.

While the tree man syndrome seems rare, research has found that 80% of the population have an asymptomatic infection of HPV (5). What this means is that most people have the disease but don’t have the genetic predisposition that causes the skin condition to manifest itself.

According to the Genetic and Rare Diseases Information Center (GARD), there are around 200 reported cases of EV around the world (6).

What Does Tree Man Syndrome Look Like?

This is one of those disorders where you know what you are looking at in the first glance.

That said, the clinically accepted signs of EV include:

  • Lifelong occurrences of pityriasis versicolor-like macules
  • Wart-like papules
  • Multiple cutaneous horn-like lesions
  • Cutaneous carcinomas (skin cancer)
  • Scaly macules on the neck, face, body, and penial region
  • Verruca-like papillomatous lesions
  • Seborrheic keratosis-like lesions
  • Red plane papules on the face, hands, and extremities

While the initial form of EV only causes wart-like lesions, its malignant form can cause multiple cancerous growths and increase the rate of polymorphic skin lesions (7).

Tree Man Syndrome Symptoms
Sahana Khatun from Bangladesh was diagnosed with EV in January 2017

What Causes Tree Man Syndrome?

EV is a genetic condition that results in a weakened immune system that’s unable to combat HPVs effectively.

This is a major problem for patients since most people have one of 150 HPVs infections.

In one report, it’s stated that 50% of patients with EV ended up with malignant tumors (8).

The genetic condition is an inactivating PH mutation in the EVER1 or EVER2 genes (9). Both these genes are found adjacent to each other on chromosome 17 and are critical players in the body’s Zinc regulation, weakening the immune system by making it susceptible to HPVs (10).

The ras homolog gene family member H is another gene that is associated with EV (11).

Well-Known Cases Of Tree Man Syndrome:

NameFromDiagnosedCurrent Status Of EV
Ion ToaderRomaniaMar-07Minor reappearances
Dede KoswaraIndonesiaNov-07Died in 2016 due to EV complications
Omar TamimIraq2013Unknown
Abul BajandarBangladeshJan-16He requested his arms to be amputated due to the pain in June 2019
Sahana KhatunBangladeshJan-17Declined further treatment
Mohammed TaluliGazaAug-17Successful surgeries to remove most lesions in 2019
Cristhél Suyapa MartínezHondurasOct-18Unknown
Dede Koswara - Tree Man Syndrome
Dede Koswara died in 2016 from complications arising from his aggressive Tree Man Syndrome

Tree Man Syndrome Treatment:

Research on EV is ongoing, but a definitive cure has yet to be found for the skin disorder.

That said, the most common treatment that may work is Acitretin (0.5-1 mg per day) for six months. This treatment stimulates the anti-proliferative and differentiation-inducing effects of the body.

Retinoids and interferons counter the Tree Man Syndrome (12). Additionally, Cimetidine and Calcipotriol may also be effective treatments (13).

Other alternatives include wart removal methods like cryotherapy and chemical treatments. However, surgical options like curettage are one of the preferred means favored by dermatologists dealing with the Treeman Syndrome.

This method uses a spoon-shaped device to carefully scrape away the lesions while preserving as much healthy skin as possible. Surgical techniques also require skin grafting to cover up the exposed skin and speed up the healing process.

An important fact to remember in regards to the treatment of EV is that early diagnosis and patient support are essential. Properly explaining what this condition is to the patients is important. In addition, it’s crucial to remove any tumoral lesions before they spread further.

Those with Tree Man Syndrome have a higher risk of skin cancer and should avoid sun exposure when possible.

Tree Man Syndrome Treatment
Surgery works best at combating EV but no cure has yet been found.

Is EV Preventable?

EV is a hereditary genetic condition. Therefore, passing it on to the next generation is a matter of chance. That said, the good news is that this is not an infections condition.

The only way to truly tell is to test your genes out to see if you have Tree Man Syndrome.

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