By Gary M. White, MD
Courtesy Michael O. Murphy, MD
Elastosis Perforans Serpiginosa (EPS) consists of annular lesions of the skin representing transepidermal elimination of abnormal elastic fibers.
Flesh-colored or slightly erythematous, hyperkeratotic papules arranged in arcs or rings on the neck in characteristic. The upper arms are next most common. Rarely other sites may be involved.
Spontaneous resolution may occur. Various destructive modalities have been used including cryotherapy, curettage, electrocautery, laser and dermabrasion. The fractional CO2 laser gave excellent results in one case [JAMA Derm 2017;153;1063]. Topical medications including imiquimod, tazarotene 0.1% gel QHS [AD 2002;169] and calcipotriene have been used.
If penicillamine is associated, stopping the drug can lead to improvement. In one patient whose EPS was caused by penicillamine, the lesions resolved after 6 weeks of isotretinoin 0.5 mg/kg/day.
For a picture of EPS associated with d-penicillamine, see Dermatology Online Journal 17 (4): 3
For a patient with Wilson's disease treated with d-penicillamine shoe developed EPS see Indian J Dermatol Venereol Leprol 2011;77:55-8
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