Tree Man Syndrome in Children Causes Symptoms and Treatment

Has your child started developing large, rough warts on their hands, feet, or other parts of the body, and seem to be easily affected with no clear reason? This could be a sign of Tree Man Syndrome in children, a very rare condition that causes the skin to grow warts resembling tree roots due to a genetic and immune system defect.In this Dalily Medical article, we’ll explain in a simple way the causes of the syndrome, its symptoms, stages, and the latest treatment options for children, including medications, surgery, and home care. You’ll also find practical tips for parents to help protect their child from complications and improve their daily quality of life.

1. What is Tree Man Syndrome in children?

Tree Man Syndrome is a rare skin disorder in children that causes the skin to grow large, rough warts resembling tree trunks. It occurs due to a genetic defect that prevents the child’s body from effectively fighting the human papillomavirus (HPV).

2. Is the condition contagious?

No, the syndrome itself is not contagious, as it is linked to the child’s genes and weakened immunity. However, the virus (HPV) that causes the warts can be transmitted to others, though most people naturally fight it off, while affected children cannot.

3. Is there a permanent cure?

Currently, there is no definitive cure, but several treatments help control symptoms:

Medications to relieve pain and manage warts.
Surgery to remove large warts.
Laser treatment for widespread warts.

4. Can the warts come back after treatment?

Yes, warts often return after a short period because the root cause is linked to genetics and immunity.

5. Does the syndrome affect internal organs?

It mostly affects the skin and extremities, but in very rare cases, warts may appear on internal organs like the lungs.

6. Can a child with the syndrome live a normal life?

With continuous medical care and psychological support, most children can lead lives close to normal. However, in some cases, the syndrome may cause:

Difficulty in movement.
Chronic pain from large warts.
Psychological issues related to appearance.

7. Are there ways to prevent it?

Direct prevention is not possible since it is genetically linked, but:

Early detection by a dermatologist.
Monitoring warts and treating them promptly.
Regular skin care.
These measures help reduce complications and control symptoms more effectively.

Causes of Tree Man Syndrome in children

Tree Man Syndrome (Epidermodysplasia verruciformis) is a very rare skin disorder, usually caused by a genetic immune defect. Main causes include:

Genetic mutation
Mutations in specific genes like EVER1 and EVER2 weaken the body’s ability to fight HPV.
Weak skin immunity
Affected children have a higher susceptibility to HPV, allowing warts to grow and spread quickly.
Family genetic factor
The condition is usually autosomal recessive, meaning the child must inherit the defective gene from both parents. It can recur in families or among siblings.
HPV infection
Children with the syndrome are more susceptible to specific HPV strains, which eventually cause large, tree trunk-like skin growths.

Symptoms of Tree Man Syndrome in children

The syndrome causes distinctive skin changes, usually starting at a young age and progressing over time:

Frequent warts: small warts appear on the face, hands, and feet.
Tree-like skin growths: warts enlarge, merge, and form thick layers resembling tree roots or bark.
Widespread distribution: growths may cover large areas, especially the hands, feet, face, and limbs.
Skin discoloration: some patches may appear brown or dark gray, with uneven skin tone.
Functional problems: difficulty using hands or walking if growths are large; may cause pain or discomfort.
Increased risk of skin cancer: due to weak skin immunity, tumors may develop over time.

Stages of Tree Man Syndrome in children

The syndrome develops gradually; stages may vary for each child:

Stage 1: Early childhood (3–7 years)
Small, flat or slightly raised warts, mainly on the face or hands. Often mistaken for normal childhood warts.
Stage 2: Middle childhood (8–12 years)
Increase in number and spread of warts. Rough or scaly patches appear. Some patches darken to brown or gray.
Stage 3: Adolescence (13–18 years)
Warts merge into thick skin masses resembling tree bark or roots. May cause difficulty moving fingers or hands. Increased sensitivity to sunlight and darker skin patches.
Stage 4: Adulthood
In some cases, there is a risk of skin tumors, especially in sun-exposed areas. Skin becomes weaker, prone to ulcers or infections, and large growths may affect hand or foot function.

Complications of Tree Man Syndrome in children

Chronic skin problems
- Large, thick warts resembling tree bark.
- Cracks and repeated infections.
- Increased susceptibility to bacterial or fungal infections.
Difficulty in movement and use
- Large growths around fingers or palms reduce the ability to grasp objects.
- May cause stiffness or restricted movement of hands and feet.
Pain and discomfort
- Some skin growths may cause chronic pain or itching.
- Pressure or friction worsens symptoms.
Psychological and social impact
- Unusual skin appearance may cause embarrassment or isolation.
- Risk of bullying at school, leading to low self-esteem or psychological disorders.
Increased risk of skin cancer
- Due to genetic mutations and weak immunity against HPV.
- Higher risk during adolescence and adulthood, especially in sun-exposed areas.

Diagnosis of Tree Man Syndrome in children

Diagnosis involves clinical examination and tests:

Clinical examination
Observation of large, branching warts resembling tree roots. Monitoring areas like hands, feet, and other body parts.
Medical and family history
Asking parents about early symptom onset and family history of immune or genetic issues.
Skin tests
Biopsy to examine the cells under a microscope and distinguish normal warts from potentially cancerous growths.
Genetic testing
Detecting gene mutations associated with the syndrome, especially in children with early-onset symptoms.
Immune tests
Evaluating the child’s immune system strength, as weak immunity accelerates wart growth.

Medical treatment for Tree Man Syndrome in children

While there is no cure, medications can help control symptoms, reduce wart size, and prevent recurrence:

Antiviral drugs
- Cidofovir or other HPV-targeting medications.
- Reduce viral activity and slow wart growth.
Immune-boosting drugs
- Interferon to stimulate the immune system.
- Helps the body fight the virus more effectively.
Vitamins and supplements
- Vitamins A, C, and zinc improve skin health and immunity.
- Used as supportive therapy.
Topical creams and ointments
- Retinoid creams or antiviral ointments applied directly to warts.
- Reduce size and soothe the skin.
Topical chemotherapy
- In severe cases, creams may stop abnormal skin cell growth.

Surgical Treatment for Tree Man Syndrome in Children

Surgery is one of the most commonly used methods to treat Tree Man Syndrome, especially when warts are large or limit the child’s movement:

Direct Surgical Removal
- The surgeon manually removes large warts using medical tools.
- Provides temporary relief and reduces pain and movement difficulties.
- Limitation: Warts may recur after a short time.
Laser Therapy
- Laser precisely destroys wart tissue.
- Suitable for cases where warts are widespread.
- Reduces bleeding and pain compared to conventional surgery.
Electrocautery
- Uses electrical current to burn and remove warts.
- Suitable for medium and small-sized warts.
Skin Grafting (for very severe cases)
- In cases of extensive skin damage, doctors may graft healthy skin onto affected areas.
- Rarely used, but considered a last resort for critical cases.

Prevention and Managing Complications of Tree Man Syndrome in Children

Although there is no definitive cure for Tree Man Syndrome, simple and effective steps can help reduce complications and control symptoms:

Regular Medical Follow-up
- Visit a dermatologist periodically to monitor wart size and progression.
- Early intervention if any suspicious skin changes appear to prevent skin cancer.
Daily Skin Care
- Keep the skin clean and free from scratches or injuries.
- Use moisturizing creams to prevent dryness and cracking.
- Avoid strong chemicals or harsh soaps that may irritate the skin.
Topical or Surgical Treatment When Needed
- Surgically remove or use laser treatment for large warts to reduce pain and improve hand/foot function.
- Use topical medications to slow wart growth and control symptoms.
Strengthening Immunity
- Provide a balanced diet rich in vitamins and minerals to support the immune system.
- Avoid frequent infections that can worsen symptoms.
Psychological and Social Support
- Support and encourage the child to overcome embarrassment or bullying due to appearance.
- Educate parents and schools about the condition to ensure a normal and supportive environment.
Sun Protection
- Apply child-safe sunscreen on exposed areas.
- Wear long cotton clothing to protect the skin from harmful sun rays, especially in affected areas.