Elastosis perforans serpiginosa (EPS) developed in three patients with Wilson disease who underwent prolonged treatment with penicillamine. The patients' clinical courses and histopathological findings were identical to those of EPS, as described in the literature. Because EPS has not been reported to occur in untreated patients with Wilson disease, penicillamine appears to be the causative factor. The lesions may represent a direct interaction of penicillamine with elastin, or they may be the indirect effect of a local copper deficiency.
Pass F, Goldfischer S, Sternlieb I, Scheinberg IH. Elastosis Perforans Serpiginosa During Penicillamine Therapy for Wilson Disease. Arch Dermatol. 1973;108(5):713-715. doi:10.1001/archderm.1973.01620260061026