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Dermoscopy of papular elastorrhexis

Zhao, Jia-Qing1; Xu, Zhe2; Wang, Bin1; Li, Yan-Jia1; Zhang, Guo-Qiang1

Editor(s): Guo., Li-Shao

Author Information
doi: 10.1097/CM9.0000000000001280
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To the Editor: Papular elastorrhexis (PE) is a rare acquired elastic tissue disease. Its etiology and pathogenesis remain unknown. PE is predisposed to the trunk and limbs and clinically presented as multiple asymptomatic, 3- to 5-mm non-follicular flesh-colored papules on children and adolescents, mainly in women. It presents only cutaneous involvement, and most of the patients are asymptomatic and often misdiagnosed and untreated. Herein, we present a case of PE and describe its dermoscopic features that have not been previously reported.

A 10-year-old girl presented to the outpatient clinic of the First Hospital of Hebei Medical University with a 5-year history of a flesh-colored papule on her back. The papule was asymptomatic and increased gradually in size. The patient was healthy with no prior history of trauma or infections at the lesional site nor a family history of similar lesions. Dermatological examination revealed a 6-mm solitary flesh-colored papule on her back. The lesion was slightly hard and well-demarcated [Figure 1A]. Dermoscopic examination revealed honeycomb-like reticular pigment surrounded by radial pigment, without vessel involvement [Figure 1B]. Histopathological analysis showed thickened or broken collagen fibrils and perivascular lymphocytic infiltration in the dermis [Figure 1C]. Elastic staining revealed thin, fragmented elastic fibers that were reduced in number [Figure 1D]. PE was diagnosed based on these features. The lesion was surgically removed. No relapse or significant changes occurred during the 1-year follow-up.

Figure 1
Figure 1:
Lesions and dermoscopic features of the patient. (A) Clinical appearance of PE with a solitary flesh-colored papule. (B) The dermoscopic appearance of PE (polarized-light pattern, non-contact, original magnification ×75). (C) Thickened or broken full dermis collagen fibrils. Sparsely distributed lymphocytes infiltrated the superficial blood vessels (hematoxylin-eosin staining, original magnification ×40). (D) Partial fragmentation, disintegration, or total loss of elastic fibers (elastic staining, original magnification ×100). PE: Papular elastorrhexis.

The clinical characteristics of PE include multiple asymptomatic, non-follicular flesh-colored papules. In our case, the lesion was solitary, which is uncommon in PE. The prominent histopathological feature of PE is reduced, fragmented, or absence of dermal elastic fibers. Collagen fibers can be normal, focally thickened, or even homogenized with a few lymphocytes infiltrated around the blood vessels.[1] Differential diagnoses include white fibrous papulosis of the neck (WFPN), which is characterized by slight, focally increased, and thickened collagen fibers in the papillary dermis, accompanied by normal or decreased elastic fibers. WFPN mainly occurs on the neck of the older individuals, related to skin aging. Minagawa et al[2] showed that WFPN presents homogeneous, white, well-circumscribed lesions punctuated with dotted, short, or thin vessels, which differed from that in our case. Differential diagnoses of PE may also include dermatofibroma, with the most prevalent dermoscopic pattern being a delicate peripheral pigmented network and a central white network.[3] Other differential diagnoses include papular acne scars, anetoderma, mid-dermal elastolysis, and postinflammatory elastolysis.[4]

Dermoscopy is non-invasive and can help to diagnose and provide differential diagnoses for dermatoses.[5] Dermoscopic features of PE may be unique and include honeycomb-like reticular pigment surrounded by radial pigment, without vessel involvement.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient's guardians have given their consent for their images and other clinical information to be reported in the article. The patient's guardians understand that their names and initials will not be published and due efforts will be made to conceal the identity of the patient, although anonymity cannot be guaranteed.

Conflicts of interest

None.

References

1. Sezer E, Durmaz EÖ, Şahin S. Papular elastorrhexis: clinical perspectives. Clin Cosmet Investig Dermatol 2018; 11:541–544. doi: 10.2147/ccid.S151020.
2. Minagawa A, Koga H, Saida T. Dermoscopy of white fibrous papulosis of the neck. Arch Dermatol 2010; 146:220doi: 10.1001/archdermatol.2009.368.
3. Juliandri J, Wang X, Liu Z, Zhang J, Xu Y. Dermoscopic patterns of dermatofibroma in 72 Chinese patients. Chin Med J 2019; 132:2121–2122. doi: 10.1097/cm9.0000000000000406.
4. Bem L, Coppini A, Padilha V, Lima BZ. Papular elastorrhexis: a rare and benign disease. An Bras Dermatol 2018; 93:573–575. doi: 10.1590/abd1806-4841.20187317.
5. Shen X, Yu RX, Shen CB, Li CX, Jing Y, Zheng YJ, et al. Dermoscopy in China: current status and future prospective. Chin Med J 2019; 132:2096–2104. doi: 10.1097/cm9.0000000000000396.
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