A case of papular elastorrhexis

Papular elastorrhexis (PE) is a rare disorder of elastic tissue characterized by asymptomatic, nonfollicular, whitish or flesh-coloured, monomorphous, discrete, oval to round papules [1–5]. One to five mm-sized papules are symmetrically distributed on the chest, abdomen, back and upper limbs [1, 3, 4]. Some PE cases may be underestimated because of the asymptomatic course of the lesions or misdiagnosed because of rarity of the disorder and similarity of the lesions to acne scars [2]. Up to now, fewer than 30 PE cases have been reported [4].
A 22-year-old man presented with asymptomatic, flesh-coloured papules on the trunk and upper arms. The lesions had first appeared when he was 13–14 years old and slowly progressed over years. He did not define antecedent trauma or local inflammation. He had acne vulgaris history and he had taken isotretinoin therapy for acne vulgaris 2 years before admission. While acne lesions regressed, the papules did not change as a result of this therapy. There were no other significant findings in his personal and family history. Dermatological examination revealed multiple 1–5 mm-sized, flesh-coloured, firm, nonfollicular discrete papules on the upper regions of the chest, back and upper arms (Figure 1). Also, keratosis pilaris was observed over the lateral surface of upper arms. Routine laboratory tests were within normal limits. Histopathological examination of papules showed perivascular mild lymphoid infiltrate in the superficial dermis and mild homogenization of collagen fibres (Figure 2 A). Fragmentation and diminution, even loss in some areas of elastic fibres were seen by Verhoeff-van Gieson staining in histopathological examination (Figure 2 B). Histopathological examination did not show any follicle in or near the lesion. The lesions were diagnosed as PE based on clinical and histopathological findings.
Papular elastorrhexis is a rare disorder with no systemic associations and family history [2, 3]. It occurs usually in childhood or adolescence such as in our patient. Most of the reported cases were female [1–4]. Histopathologically, PE displays prominent fragmentation and loss of elastic fibres with or without changes in collagen bundles in the dermis [3].
Differential diagnosis of PE consists of many dermatological entities such as nevus anelasticus, abortive form of Buschke-Ollendorff syndrome, anetoderma, papular acne scars (Table 1). It is controversial whether PE is a distinctive entity or not...


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