REPORT OF A CASE
In 1975, a 29-year-old white woman was diagnosed with Wilson's disease by neurologic examination and the presence of Kayser-Fleischer rings. She was given penicillamine (0.5 mg twice daily), which reversed most of her symptoms, and the Kayser-Fleischer rings disappeared. Approximately 14 years later, an acneiform eruption developed on her neck that persisted for 1 year.Physical examination revealed erythematous papules in an arciform pattern on the anterior neck (Figure 1). A lesional skin specimen was obtained and submitted for histopathologic examination (Figures 2 through 4). These lesions failed to respond to intralesional triamcinolone acetonide but later improved with liquid nitrogen cryotherapy.What is your diagnosis?
Elastosis perforans serpiginosa (EPS).
Individual papules consisted of a reactive thickened epidermis, increased dermal elastin, and inflammation. The epidermis was hyperkeratotic and acanthotic. Occasionally, the epidermis was disrupted by transepidermal
Kuhn CA, Helm TN, Bergfeld WF, Glanz S, Steck WD. Acneiform Papules on the Neck. Arch Dermatol. 1995;131(3):341-342. doi:10.1001/archderm.1995.01690150105021