Elephantiasis nostras verrucosa (ENV) is a somewhat rare complication of nonfilarial chronic lymphedema that arises from a variety of obstructive diseases of the lymphatic system. The blocked lymphatic channels lead to protein-rich fluid in the dermis and subcutaneous tissues and brawny edema. The subsequent changes of ENV consist of increased girth of the affected body part (usually the lower limb), woody induration, and cutaneous changes, including hyperkeratosis, a cobblestone or papillated appearance, and verrucous papules.

Causes of nonfilarial chronic lymphedema include conditions that block lymphatic drainage: congestive heart failure, deep vein thrombosis, morbid obesity, recurrent staphylococcal or streptococcal infections, malignancies (such as lymphoma), and prior surgery or trauma.

ENV is a progressive condition that, left untreated, results in ongoing deformity and disability. Complications include lymphorrhea, infection, secondary ulceration, and poor wound healing.