Background: Epidermodysplasia verruciformis (EV) is a rare cutaneous disorder characterised by persistent, refractory infection with human papillomaviruses (HPV). Although EV does not seem to have racial or geographic preference, there is a scarcity of reports on its occurrence in Africans.

Methods: Twenty Africans with EV were studied, and the literature on this condition in Africans was reviewed. Virologic studies were performed on 10 patients.

Results: Three types of lesions were observed: flat warts, pityriasis versicolor-like macules, and seborrheic keratosis-like changes. Malignant transformation occurred in only one patient. HPV-3 was isolated only from flat warts, HPV-5 and HPV-17 were isolated only from PV-like lesions, whereas an HPV-5-related type was found in all three types of changes. HPV-5-related type revealed DNA that was related but not identical to any of the viruses in the HPV-5 group. This particular type was isolated from all five South African patients with EV in whom virologic studies were performed.

Conclusions: The benign nature of EV in dark-skinned Africans has been confirmed. Four HPV types have been isolated, of which HPV-related type was found in all South African patients with EV and in all types of skin changes, regardless of their morphology. African patients with EV frequently present seborrheic keratosis-like changes.