Elastosis perforans serpiginosa (EPS) is a rare skin condition characterized by hyperkeratotic papules and transepidermal elimination of abnormal elastic fibers.1 The treatment of EPS remains highly challenging, and the location of the lesions mainly on sensitive areas complicates the therapeutic approach.
We report the case of a woman in her 40s with a history of EPS after prolonged administration of D-penicillamine for Wilson disease. The EPS lesions were located first on the neck (Figure, A) and the buttocks. Later, the inguinal and elbow folds and the perineum were progressively affected. Several treatments had been attempted, including topical retinoids, topical imiquimod, cryotherapy, and photodynamic therapy. The tolerance of these treatments was poor, with frequent irritation, and none of them provided any efficacy.