Tree Person Syndrome (Epidermodysplasia Verruciformis)

Tree person syndrome is a rare inherited condition that causes wart-like growths or brown, scaly patches (plaques) to form on your skin. These plaques can build up in layers that look like tree bark. They usually appear after a human papillomavirus (HPV) infection.

The condition is often called “tree man syndrome.” But healthcare providers no longer use that name, as it can affect anyone, not just males. You might also hear it called human tree disease. The medical name for this condition is epidermodysplasia verruciformis (EV).

Tree person syndrome is extremely rare. There have been just over 500 reported cases worldwide in medical history.

Types of tree person syndrome

There are two types based on the cause:

• Inherited (genetic): This type passes down through biological families.
• Acquired (non-genetic): This type develops with a weakened immune system.

What does tree person syndrome look like?

Signs of tree person syndrome include:

• Small, flat bumps that look like warts (brown to red)
• Dry, rough, scaly patches of skin
• Overlapping or cluster or bumps (lesions) that look like tree bark
• Patches of skin with discoloration (lighter or darker than your natural tone)

The skin growths may hurt because they reach below the surface of your skin and press on nearby nerves.

Where do symptoms affect my body?

Symptoms can affect any part of your body with skin. But it most often affects your:

• Arms
• Face
• Feet
• Hands
• Legs
• Neck
• Trunk

It usually affects parts of your skin that get a lot of sun exposure.

Tree person syndrome causes

Tree person syndrome happens when your body can’t control certain types of human papillomavirus (HPV). These HPV types (mainly HPV 5, 8 and related strains) are different from the ones that cause common warts or genital warts. Most people’s immune systems can stop these viruses. But with this condition, your skin’s defenses don’t work the way they should. This lets the virus grow and form wart-like patches.

Some people are born with a genetic change that causes this condition. It’s passed down in families when both biological parents carry the same gene change.

Other people develop it later in life because their immune systems become weak. This can happen with conditions like HIV, or after organ transplants or cancer treatments. Sometimes, skin growths can appear after an injury or infection if your immune system isn’t working well.

While HPV infections are very common, tree person syndrome only develops in people whose immune systems can’t defend these skin-specific viruses.

Risk factors

You’re more at risk of developing this condition if the genetic variant that causes it runs in your biological family history. Sometimes, the condition happens without a known genetic history. In this case, you’re more likely to develop it if you have a weakened immune system.

Complications of tree person syndrome

People with this condition have a higher risk of developing non-melanoma skin cancer, especially squamous cell carcinoma. These cancers often appear on parts of your skin that get a lot of sun. They usually develop between the ages of 30 and 40.

Because the growths can be hard to manage and often appear in visible areas, they can also affect your emotional well-being. You may feel anxious, depressed or want to avoid social situations because of skin symptoms.

How doctors diagnose tree person syndrome

A healthcare provider can diagnose this condition with a physical exam to review your symptoms. They’ll also ask about your personal and family medical history. To confirm the diagnosis, your provider may order tests like:

• A genetic test
• A skin biopsy
• A PCR test for HPV

Tree person syndrome treatment

There isn’t a cure for this condition yet, but your healthcare provider can help you manage symptoms and lower your risk of complications. They may recommend:

• Surgical removal (excision): Your provider may remove large or suspicious growths. This can improve comfort and reduce the risk of skin cancer.
• Oral retinoid medicine (acitretin): These vitamin A-based pills may slow down or reduce the growth of warts.
• Topical creams (imiquimod or calcipotriol): These may boost your skin’s immune response or manage cell growth in affected areas.
• Interferon with retinoids: A combination treatment that may help your body fight the HPV infection in your skin.

Your provider may also suggest:

• Avoiding radiation therapy: Radiation may make these growths worse, but there are some exceptions.
• Getting regular dermatology check-ups: This helps your care team look out for complications.
• Protecting your skin from the sun: Sun exposure increases the risk of skin cancer.

When should I see my healthcare provider?

See a healthcare provider if you notice new skin changes, like warts or growths that don’t go away.

If you have this condition, you’ll need regular follow-up visits with a dermatologist. Visits usually happen at least once a year, or more often if needed. Your provider will monitor your skin and adjust your treatment as necessary. Contact your provider sooner if you notice severe pain or any new or worsening symptoms between visits.

What questions should I ask my healthcare provider?

It’s normal to have a lot of questions. Your provider can help you answer them. Here are a few to get started:

• What types of treatment do you recommend?
• Are there side effects to the treatment?
• Are there clinical trials that I can try?
• Are there certain skin care products I should avoid?

What can I expect if I have tree person syndrome?

This condition generally has a good outlook because it affects only your skin, not your internal organs. But it’s a lifelong condition. And symptoms can come back after removal. While there’s no cure, treatment can help manage symptoms and improve your comfort.

Your care team will monitor your skin regularly and teach you what to watch for between visits. Let your provider know right away if you notice any new or changing growths. Catching skin cancer early makes it easier to treat.

Living with this condition can also take an emotional toll. It’s completely understandable to feel frustrated or isolated. Talking with a mental health professional can help you cope and find ways to feel supported.