Elastosis perforans serpiginosa- A rare case report

Elastosis perforans serpiginosa is a rare primary perforating disorder. In EPS, there is elimination of altered elastic fibres from papillary layer of dermis to epidermis which is described as transelimination disorder. It is characterized as multiple hyperkeratotic umbilicated papule which are arranged in annular or serpiginous pattern with raised edge and central plug. These are more commonly distributed over back, sides of neck and extremities in bilateral symmetrical pattern. It is common in age group of 5 to 20 years with male predominance. Lesions are generally self limiting in nature. Isotretinoin is used in penicillamine induced disease. A 45 year old diabetic female presented with chief complaints of asymptomatic dark coloured raised lesions on face, sides of neck and upper extremities in bilateral symmetrical pattern for last four years. On cutaneous examination multiple asymptomatic hyperpigmented keratotic papular lesions, coalescing to form plaques were arranged in annular, serpiginous and polycyclic pattern over face, sides of neck, chest and forearms distributed in bilaterally symmetrical pattern with central sparing and atrophy. Patient underwent general and systemic examination followed by routine and histopathological examination. Routine investigations were normal except random blood sugar and HBA1C levels were raised. Histopathological examination revealed hyperkeratotic and acanthotic epidermis with transepidermal channels having nuclear debris and elastic fibres. Patient was explained about course and prognosis of disease and was stared on topical and oral retinoids. Later, she was lost follow up. Keywords: Elastosis perforans serpiginosa, Perforating disorder, Rare.