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
Table of Contents
Definition / general | Epidemiology | Microscopic (histologic) description | Microscopic (histologic) images | Positive stains | Differential diagnosisCite this page: Hamodat M. Perforating dermatoses. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/skinnontumorelastosisperforans.html. 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
Epidemiology
- 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
Images hosted on other servers:
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
