Skin-nontumor / Clinical dermatology
Other dermatoses
Elastosis perforans serpiginosum

Author: Mowafak Hamodat, M.D., MB.CH.B, MSc., FRCPC (see Authors page)

Revised: 24 June 2016, last major update July 2011

Copyright: (c) 2002-2016,, Inc.

PubMed Search: Elastosis perforans serpiginosum

Cite this page: Elastosis perforans serpiginosum. website. Accessed July 16th, 2018.
Definition / general
  • Rare skin disease in which abnormal elastic tissue fibers, other connective tissue elements and cellular debris are expelled from papillary dermis through epidermis (eMedicine)
  • Back of neck in teenage boys
  • Either idiopathic, drug-induced (D-penicillamine), or associated with other inherited disorders (Downs syndrome, Éhlers Danlos syndrome, osteogenesis imperfecta, Marfan’s syndrome, Rothmund–Thomson syndrome)
Diagrams / tables

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Clinical images

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Elastosis perforans serpiginosa

Microscopic (histologic) description
  • Clumps of coarse elastic fibers penetrate epidermis and cause focal epidermal hyperplasia
  • Marked increase in elastic tissue in both reticular and papillary dermis
  • The vertically oriented fibers of the papillary dermis are thicker than normal
  • The center of the lesion shows characteristic transepithelial, parafollicular or transfollicular fibers that are straight, wavy or screw-like in configuration
  • The perforating canal contains degenerated epithelial cells, inflammatory debris and numerous elastic fibers
  • The epithelium on either side of the perforating canal is acanthotic, often with pseudoepitheliomatous hyperplasia
  • Foreign body giant cell reaction is common in superficial dermis; occasionally elastophagocytosis is present
Microscopic (histologic) images

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Various images

Positive stains
  • Elastic stains (highlights elastic fibers)
Differential diagnosis
  • Kyrle’s disease: transepidermal degeneration of parakeratin and inflammatory debris
  • Perforating folliculitis: transepidermal elimination of degenerative connective tissue
  • Reactive perforating collagenosis: transepidermal elimination of collagen