Elastosis perforans serpiginosum

Synonym:

Perforating serpiginous elastosis
Perforating elastoma
Elastoma intrapapillare perforans

Altered elastin, possibly secondary to a genetically determined defect, is extruded through the epidermis.

Typically appearing in late childhood to early adulthood, keratotic papules with a horny plug occur in a serpiginous pattern. These rings of papules can expand peripherally, leaving atrophic skin in their wake.

Typically, lesions occur on the sides and back of the neck.

Many cases are associated with connective tissue syndromes such as Ehlers-Danlos syndrome, Marfan's syndrome, pseudoxanthoma elasticum and osteogenesis imperfecta. It has also been associated with Down's syndrome, and can occur in otherwise normal individuals.

Drug induced causes include penicillamine.

Treatment:

• Lesions clear spontaneously with scarring.
• Cryotherapy or curettage may speed the process of resolution.

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