|THROUGH THE LENS
|Year : 2014 | Volume
| Issue : 2 | Page : 236-237
Elastosis perforans serpiginosa
Ludimila Noleto de Rezende1, Mónica Gauto Nuñez1, Thaís Genn Clavery1, Eneida Genn Constancio2, Mayra Carrijo Rochael3, Gabriela Juncá T Pires2, Omar Lupi4
1 Department of Dermatology, General Polyclinic of Rio de Janeiro, Rio de Janeiro, Brazil
2 The Brazilian Society of Dermatology, Universidade Federal Fluminense, Division of Dermatopathology, Universidade Federal Fluminense, Niterói, Brazil
3 Department of Pathology, Universidade Federal Fluminense, Division of Dermatopathology, Universidade Federal Fluminense, Niterói, Brazil
4 Department of Medical Specialties, School of Medicine and Surgery, Federal University of Rio de Janeiro State, General Polyclinic of Rio de Janeiro, Rio de Janeiro, Brazil
|Date of Web Publication||21-Apr-2014|
Ludimila Noleto de Rezende
Rua da Passagem, 101/304 A, Botafogo, Rio de Janeiro - RJ, CEP: 22290-030
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
de Rezende LN, Nuñez MG, Clavery TG, Constancio EG, Rochael MC, Pires GT, Lupi O. Elastosis perforans serpiginosa. Indian Dermatol Online J 2014;5:236-7
|How to cite this URL:|
de Rezende LN, Nuñez MG, Clavery TG, Constancio EG, Rochael MC, Pires GT, Lupi O. Elastosis perforans serpiginosa. Indian Dermatol Online J [serial online] 2014 [cited 2020 Apr 5];5:236-7. Available from: http://www.idoj.in/text.asp?2014/5/2/236/131156
A 22-year-old male patient, African descent, in august 2011, complained of "dots in his arms," for one year duration, associated with slight pruritus. The patient had obesity level II and high blood pressure, on regular hydrochlorothiazide and losartan.
On clinical examination, erythematous papules with central crusts, coalescing to form serpiginous lesions were seen over arms, [Figure 1] and [Figure 2]. It was suggestive of elastosis perforans serpiginosa (EPS) and a biopsy was carried out in the right arm lesions.
|Figure 1: Erythematous papules with central crusts, coalescing to form serpiginous lesions over right arm|
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Histopathological examination of the material, subjected to special Weigert staining, showed fragmented elastic fibers in the base of the perforation, with less intense staining of epidermal depression [Figure 3] and [Figure 4]. Therefore, the diagnosis was confirmed.
EPS is a rare skin condition included among the primary perforating dermatoses of dermal origin characterized by the transepidermal extrusion of elastic fibers. The etiopathogenesis may be considered idiopathic or associated with Down's syndrome, hereditary diseases of the connective tissue, and the use of D-penicillamine.  EPS should be suspected in a patient presenting with keratotic papules, asymptomatic or pruriginous plaques grouped in an arciform or serpiginous pattern. The diagnosis is confirmed by histopathology (gold standard). Clinically, the differential diagnoses are granuloma annulare, tinea corporis, annular sarcoidosis, cutaneous calcinosis, and porokeratosis of Mibelli. The treatment options explored in published articles were cryotherapy, topical tretinoin, 0.1% tazarotene gel, oral isotretinoin, imiquimod, carbon dioxide laser (CO 2 laser) and pulsed dye laser, all these results with some constant, varying greatly between authors. ,,
In this case, patient was given the option of treatment with CO 2 laser and cryotherapy. The patient opted for cryotherapy and after the first session, the lesions showed partial improvement, with mild hypochromia in some larger lesions.
| References|| |
|1.||Atzori L, Pinna AL, Pau M, Aste N. D-penicillamine elastosis perforans serpiginosa: Description of two cases and review of the literature. Dermatol Online J 2011;17:3. |
|2.||Kaufman AJ. Treatment of elastosis perforans serpiginosa with the flashlamp pulsed dye laser. Dermatol Surg 2000;26:1060-2. |
|3.||Ratnavel RC, Norris PG. Penicillamine-induced elastosis perforans serpiginosa treated successfully with isotretinoin. Dermatology 1994;189:81-3. |
|4.||Tuyp EJ, McLeod WA. Elastosis perforans serpiginosa: Treatment with liquid nitrogen. Int J Dermatol 1990;29:655-6. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4]