Through the Lens
Elastosis perforans serpiginosa Ludimila Noleto de Rezende, Mónica Gauto Nuñez, Thaís Genn Clavery, Eneida Genn Constancio1, Mayra Carrijo Rochael2, Gabriela Juncá T. Pires1, Omar Lupi3 Department of Dermatology, General Polyclinic of Rio de Janeiro, Rio de Janeiro, Brazil, 1The Brazilian Society of Dermatology, 2 Department of Pathology, Universidade Federal Fluminense, Division of Dermatopathology, Universidade Federal Fluminense, Niterói, 3 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
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, [Figures 1 and 2]. It was suggestive of elastosis perforans serpiginosa (EPS) and a biopsy was carried out in the right arm lesions. 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 [Figures 3 and 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
Access this article online Website: www.idoj.in DOI: 10.4103/2229-5178.131156 Quick Response Code:
Address for correspondence: Dr. Ludimila Noleto de Rezende, Rua da Passagem, 101/304 A, Botafogo, Rio de Janeiro ‑ RJ, CEP: 22290‑030, Brazil. E‑mail: ludimila_ [email protected]
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Figure 1: Erythematous papules with central crusts, coalescing to form serpiginous lesions over right arm
Figure 2: Close up view of the right arm
Figure 3: fragmented elastic fibers in the base of the perforation
Figure 4: less intense staining of epidermal depression
Indian Dermatology Online Journal - April-June 2014 - Volume 5 - Issue 2
de Rezende, et al.: Elastosis perforans serpiginosa
may be considered idiopathic or associated with Down’s syndrome, hereditary diseases of the connective tissue, and the use of D‑penicillamine.[1] 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 (CO2 laser) and pulsed dye laser, all these results with some constant, varying greatly between authors.[2‑4] 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
Indian Dermatology Online Journal - April-June 2014 - Volume 5 - Issue 2
partial improvement, with mild hypochromia in some larger lesions.
REFERENCES 1.
2. 3.
4.
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. Kaufman AJ. Treatment of elastosis perforans serpiginosa with the flashlamp pulsed dye laser. Dermatol Surg 2000;26:1060‑2. Ratnavel RC, Norris PG. Penicillamine‑induced elastosis perforans serpiginosa treated successfully with isotretinoin. Dermatology 1994;189:81‑3. Tuyp EJ, McLeod WA. Elastosis perforans serpiginosa: Treatment with liquid nitrogen. Int J Dermatol 1990;29:655‑6.
Cite this article as: 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. Source of Support: Nil, Conflict of Interest: None declared.
237
Copyright of Indian Dermatology Online Journal is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Elastosis perforans serpiginosa Ludimila Noleto de Rezende, Mónica Gauto Nuñez, Thaís Genn Clavery, Eneida Genn Constancio1, Mayra Carrijo Rochael2, Gabriela Juncá T. Pires1, Omar Lupi3 Department of Dermatology, General Polyclinic of Rio de Janeiro, Rio de Janeiro, Brazil, 1The Brazilian Society of Dermatology, 2 Department of Pathology, Universidade Federal Fluminense, Division of Dermatopathology, Universidade Federal Fluminense, Niterói, 3 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
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, [Figures 1 and 2]. It was suggestive of elastosis perforans serpiginosa (EPS) and a biopsy was carried out in the right arm lesions. 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 [Figures 3 and 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
Access this article online Website: www.idoj.in DOI: 10.4103/2229-5178.131156 Quick Response Code:
Address for correspondence: Dr. Ludimila Noleto de Rezende, Rua da Passagem, 101/304 A, Botafogo, Rio de Janeiro ‑ RJ, CEP: 22290‑030, Brazil. E‑mail: ludimila_ [email protected]
236
Figure 1: Erythematous papules with central crusts, coalescing to form serpiginous lesions over right arm
Figure 2: Close up view of the right arm
Figure 3: fragmented elastic fibers in the base of the perforation
Figure 4: less intense staining of epidermal depression
Indian Dermatology Online Journal - April-June 2014 - Volume 5 - Issue 2
de Rezende, et al.: Elastosis perforans serpiginosa
may be considered idiopathic or associated with Down’s syndrome, hereditary diseases of the connective tissue, and the use of D‑penicillamine.[1] 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 (CO2 laser) and pulsed dye laser, all these results with some constant, varying greatly between authors.[2‑4] 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
Indian Dermatology Online Journal - April-June 2014 - Volume 5 - Issue 2
partial improvement, with mild hypochromia in some larger lesions.
REFERENCES 1.
2. 3.
4.
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. Kaufman AJ. Treatment of elastosis perforans serpiginosa with the flashlamp pulsed dye laser. Dermatol Surg 2000;26:1060‑2. Ratnavel RC, Norris PG. Penicillamine‑induced elastosis perforans serpiginosa treated successfully with isotretinoin. Dermatology 1994;189:81‑3. Tuyp EJ, McLeod WA. Elastosis perforans serpiginosa: Treatment with liquid nitrogen. Int J Dermatol 1990;29:655‑6.
Cite this article as: 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. Source of Support: Nil, Conflict of Interest: None declared.
237
Copyright of Indian Dermatology Online Journal is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
