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Annular and Keratotic Papules and Plaques in a Teenager—Diagnosis
Arch Dermatol. 2009;145(8):931-936.
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Diagnosis: Elastosis perforans serpiginosa (EPS).
MICROSCOPIC FINDINGS
Scanning magnification of histologic sections revealed a focal area of epidermal acanthosis with overlying parakeratosis and, at a higher magnification, basophilic aggregates composed of collagen fibers, inflammatory cells, and swollen and clumped dermal elastin fibers present at the base of an epidermal channel. A Verhoeff–van Gieson stain highlighted the predominant component of the clumps to be abnormal, elastic fibers within the channel (Figure 3).
DISCUSSION
Elastosis perforans serpiginosa is a rare perforating disorder, which usually begins during adolescence or early adulthood with a male predominance of 4:1, and is characterized by extrusion of altered elastic fibers through the epidermis.1 Approximately one-third of cases occur in patients with genetic disorders, including Down syndrome, Ehlers-Danlos syndrome, osteogenesis imperfecta, Marfan syndrome, pseudoxanthoma elasticum, and Rothmund-Thomson syndrome.2 Penicillamine use may also cause EPS.3 Clinically, EPS presents as keratotic 2- to 5-mm papules, which tend to be arranged in serpiginous or annular patterns, most commonly on . . . [Full Text of this Article]
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Arch Dermatol. 2009;145(8):931-936.
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