Vulvar giant verrucous xanthoma associated with extensive limb involvement treated with bleomycin A5 hydrochloride

Dear Editor, Verruciform xanthoma (VX) is a rare benign hyperplastic disease frequently manifesting in the oral cavity, perineum, limbs, trunk, and occasionally the esophagus. The etiology of this condition remains elusive, possibly associated with severe skin trauma and chronic inflammation. Treatment includes surgery, imiquimod and tacrolimus application, cryotherapy, laser treatment, electroresection with snare, and oral administration of acitretin capsules. Notably, we have successfully treated VX in challenging anatomical regions using local injections of bleomycin (BLM) A5 hydrochloride, an approach that has not been previously reported. [...].