Ann Dermatol.  2014 Feb;26(1):103-106. 10.5021/ad.2014.26.1.103.

Elastosis Perforans Serpiginosa

• Lee SH
• Choi Y
• Kim SC

• KMID: 2265706
• DOI: http://doi.org/10.5021/ad.2014.26.1.103

Abstract

Elastosis perforans serpiginosa is a rare skin disease characterized by transepidermal elimination of abnormal elastic fibers. This condition classically presents as small papules arranged in serpiginous or annular patterns on the neck, face, arms, or other flexural areas. While these lesions may spontaneously resolve, they often persist for longer periods of time. Though numerous treatment modalities have been described in the literature, most are not very effective. A 35-year-old man presented to Gangnam Severance Hospital with a 2-year history of skin eruptions on his neck, which were refractory to topical antifungal or steroid treatment. On examination, the patient showed multiple crusted and erythematous papules arranged in an annular pattern with central clearing. A biopsy specimen revealed acanthosis with notable transepidermal elimination of nuclear debris and eosinophilic degenerated elastic fibers from the dermis via an epidermal channel. Verhoeff-van Gieson staining showed dense clumps of altered elastic fibers in the papillary dermis. Based on these findings, a diagnosis of elastosis perforans serpisinosa was made. Treatment with topical 0.05% tretinoin application for 6 months resulted in no improvement.

Keyword

Elastosis perforans serpiginosa; Therapeutics

MeSH Terms

Adult
Arm
Biopsy
Dermis
Diagnosis
Elastic Tissue
Eosinophils
Humans
Neck
Skin
Skin Diseases
Tretinoin
Tretinoin

Figure

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  Fig. 1 Crusted erythematous papules (2~5 mm in size) arranged in an annular pattern.

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  Fig. 2 (A) Focal epidermal hyperplasia with the formation of narrow vertical transepidermal channels (H&E, ×40). (B) Nuclear debris and eosinophilic-degenerated elastic fibers present in multiple channel lumens (H&E, ×400). (C) An inflammatory cell infiltrate consisting of lymphocytes and histiocytes was present in the papillary and superficial reticular dermis (H&E, ×400). (D) Many dense clumps consisting of altered elastic fibers in the upper dermis (Verhoeff-van Gieson stain, ×200).

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