Four types of elastosis perforans serpiginosa (EPS) have been described in
literature 1) idiopathic EPS, 2) reactive perforating elastosis associated with
connective tissue disorders, 3) in some instances of
pseudoxanthoma elasticum (PXE),
disease-specific calcified
elastic tissue is extruded, producing a clinical picture indistinguishable from other types, may also be seen in
patients undergoing
hemodialysis and 4) EPS induced by long-term
treatment with
D-penicillamine is observed in
patients suffering from
Wilson's disease. Long term
D-penicillamine therapy causes an alteration in the dermal
elastic tissue.
D-penicillamine induced EPS has a distinctive histopathologic feature - serrated appearance of
elastic fibers due to perpendicular budding from their surface giving a "lumpy-bumpy" look.
D-penicillamine induced
elastic fiber alteration may not always manifest clinically as EPS. We
report a case of
D-penicillamine induced widespread alteration in
skin elastic tissue with distinct histopathologic features.