A 75-year-old Black woman with a history of hypertension and hyperlipidemia presented to the dermatology clinic for vulvar pruritus. Examination of her flexures revealed yellow, xanthoma-like papules coalescing into plaques. Prominent sagging of the skin (Figure) was noted in the axillae (left) and proximal inner thighs (right). The cutaneous changes began in early childhood, and her ophthalmologic history included retinal angioid streaks, glaucoma, and macular degeneration. Histologic examination of a punch biopsy from the vulva displayed fragmented and calcified elastic fibers throughout the reticular dermis, simulating a “bramble bush” pattern that is characteristic of pseudoxanthoma elasticum (PXE).