The initial form of EV presents with only flat, wart-like lesions over the body, whereas the malignant form shows a higher rate of polymorphic skin lesions and development of multiple cutaneous tumors.Generally, cutaneous lesions are spread over the body, but some cases have only a few lesions which are limited to one extremity. Genetics
Most patients with classic EV carry bialletic loss-of-function mutations of transmembrane channel-like protein 6 (TMC6; also called EV protein 1, EVER1), TMC8 (also called EVER2), or calcium- and integrin-binding protein 1 (CIB1). The EVER1 or EVER2 genes are located adjacent to one another on chromosome 17. These genes play a role in regulating the distribution of zinc in the cell nuclei. Zinc is a necessary cofactor for many viral proteins, and the activity of EVER1/EVER2 complex appears to restrict the access of viral proteins to cellular zinc stores, limiting their growth.Other genes have also rarely been associated with this condition. These include the ras homolog gene family member H.

Treatment
No curative treatment against EV has been found yet. Several treatments have been suggested, and acitretin 0.5–1 mg/day for 6 months duration is the most effective treatment owing to antiproliferative and differentiation-inducing effects. Interferons can also be used effectively together with retinoids.Cimetidine was reported to be effective because of its depressing mitogen-induced lymphocyte proliferation and regulatory T cell activity features. A report by Oliveira et al. showed that cimetidine was ineffective. Hayashi et al.
applied topical calcipotriol to a patient with a successful result.As mentioned, various treatment methods are offered against EV; however, most importantly, education of the patient, early diagnosis, and excision of the tumoral lesions take preference to prevent the development of cutaneous tumors. Notable cases
Ion Toader
In March 2007, a Romanian man named Ion Toader was diagnosed with this condition. A patient of dermatologist Carmen Madeleine Curea, his pictures appeared on numerous blogs and Romanian press sources. Curea works with Spitalul Clinic Colentina in Bucharest, Romania. Stephen Stone, past president of the American Academy of Dermatology, confirmed that this was Lewandowsky–Lutz. Toader underwent surgery in late 2013, and since then has been mostly symptom-free, with only small reappearances. Dede Koswara
In November 2007, a video of a 35-year-old Indonesian man named Dede Koswara with a similar disease appeared on the Internet. His story appeared on the U.S. Discovery Channel and TLC series My Shocking Story (Extraordinary People on UKs Five) in the episode "Half Man Half Tree". On August 12, 2008, Koswaras story was the subject of an ABCs Medical Mystery episode entitled "Tree Man".On 26 August 2008, Koswara returned home following surgery to remove 6 kg (13 lb) of warts from his body. The surgery consisted of three steps:

Removal of the thick carpet of warts and massive horns on his hands
Removal of the smaller warts on his head, torso, and feet
Covering of the hands with grafted skinIn all, 96% of the warts were removed.