Skin nontumor

Dermal collagen and elastic tissue alterations, and cutaneous deposits

Perforating dermatoses

Last author update: 1 July 2011
Last staff update: 20 April 2023

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PubMed Search: Elastosis perforans serpiginosum

Mowafak Hamodat, M.B.Ch.B., M.Sc.
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Cite this page: Hamodat M. Perforating dermatoses. website. Accessed September 25th, 2023.
Definition / general
  • Elastosis perforans serpiginosum: rare skin disease in which abnormal elastic tissue fibers, other connective tissue elements and cellular debris are expelled from papillary dermis through epidermis (eMedicine: Elastosis Perforans Serpiginosum [Accessed 27 August 2018]); often back of neck in teenage boys
  • Reactive perforating collagenosis: rare skin disease of transepidermal elimination of altered collagen via the epidermis, either inherited or acquired and associated with diabetes melliltus or end stage renal disease
  • Either idiopathic, drug induced (D-penicillamine), or associated with other inherited disorders (Down syndrome, Ehlers-Danlos syndrome, osteogenesis imperfecta, Marfan syndrome, Rothmund-Thomson syndrome)
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 disease: transepidermal degeneration of parakeratin and inflammatory debris
  • Perforating folliculitis: transepidermal elimination of degenerative connective tissue
  • Reactive perforating collagenosis: transepidermal elimination of collagen
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