To the Editor.—
Transepithelial elimination (TE) is a recognized mechanism in the formation of keratotic papules and nodules in a variety of skin diseases. Dermatoses displaying this phenomenon include calcinosis cutis, osteoma perforans, granuloma annulare, elastosis perforans serpiginosa, reactive perforating collagenosis, and perforating folliculitis, as initially reported by Mehregan.1 This list has been expanded to include Kyrle's disease,2,3 necrobiosis lipoidica,4 pseudoxanthoma elasticum,5 chondrodermatitis nodularis chronica helicis,6 cutaneous chromomycosis,7 eruptive vellus hair cysts,8 and malignant melanoma.9Transepithelial elimination can be suspected clinically when indolent keratotic papules fail to respond to treatment that is usually successful in diseases displaying a localized epidermal hypertrophy. The histologic pattern of TE is essentially the same within this heterogenous group and consists of the following: (1) epidermal hyperplasia, (2) a central crater with a keratinous plug, (3) direct communication of the crater to histochemically altered material in the
Bard JW. Transepithelial Elimination in Papular Mucinosis. Arch Dermatol. 1983;119(2):95–97. doi:10.1001/archderm.1983.01650260003002
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