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A man in his 60s presented in reduced general condition and with asymptomatic brownish-red papules organized in multiple arcuate to annular formations on his upper trunk and arms (Figure 1). A prominent cutis laxa and cutis rhomboidalis nuchae were noted. At the time of presentation, he had been treated for Wilson disease with daily doses of D-penicillamine (1.0-1.5 g/d) for more than 40 years.
Histopathologic analysis revealed channels through the epidermis formed by follicular epithelium (Figure 2A). The infundibula were filled with granular cellular debris, neutrophils, and corneocytes (Figure 2A and C). The interfollicular tissue showed a mixed inflammatory infiltrate. Elastica van Gieson staining demonstrated an accumulation of altered elastic fibers (Figure 2B) within the upper part of the dermis.
Hellriegel S, Bertsch HP, Emmert S, Schön MP, Haenssle HA. Elastosis Perforans Serpiginosa: A Case of a Penicillamine-Induced Degenerative Dermatosis. JAMA Dermatol. 2014;150(7):785–787. doi:10.1001/jamadermatol.2013.8635
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