Dermoscopy of Papular Elastorrhexis
Papular elastorrhexis (PE) is a rare acquired elastic tissue disorder whose etiology and pathogenesis remain largely unknown. The condition predominantly affects the trunk and limbs, presenting as multiple asymptomatic, flesh-colored papules measuring 3 to 5 mm in diameter. These papules are non-follicular and typically appear in children and adolescents, with a higher prevalence among females. PE is characterized by cutaneous involvement only, and most patients remain asymptomatic. Due to its rarity and nonspecific clinical presentation, PE is often misdiagnosed or left untreated. This article presents a case of PE and describes its dermoscopic features, which have not been previously reported in the literature.
Case Presentation
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 lesion was asymptomatic and had gradually increased in size over time. The patient was otherwise healthy, with no history of trauma or infections at the lesional site. There was also no family history of similar lesions. Dermatological examination revealed a solitary, well-demarcated, flesh-colored papule measuring 6 mm in diameter. The lesion was slightly firm to the touch.
Dermoscopic Examination
Dermoscopic examination of the lesion revealed a honeycomb-like reticular pigment pattern surrounded by radial pigment. Notably, there was no evidence of vascular involvement. This unique dermoscopic feature distinguishes PE from other dermatological conditions that may present with similar clinical appearances.
Histopathological Analysis
Histopathological analysis of the lesion showed thickened or fragmented collagen fibrils in the dermis, accompanied by perivascular lymphocytic infiltration. Elastic staining further revealed thin, fragmented elastic fibers that were significantly reduced in number. These histopathological findings are consistent with the diagnosis of PE, which is characterized by the reduction, fragmentation, or complete absence of dermal elastic fibers.
Diagnosis and Treatment
Based on the clinical, dermoscopic, and histopathological findings, a diagnosis of PE was confirmed. The lesion was surgically removed, and the patient was followed up for one year. During this period, there was no recurrence or significant changes at the site of the lesion.
Clinical Characteristics of Papular Elastorrhexis
PE typically presents as multiple asymptomatic, non-follicular, flesh-colored papules. However, in this case, the lesion was solitary, which is uncommon for PE. The most prominent histopathological feature of PE is the reduction, fragmentation, or absence of dermal elastic fibers. Collagen fibers may appear normal, focally thickened, or homogenized, with a sparse infiltration of lymphocytes around blood vessels.
Differential Diagnoses
The differential diagnoses for PE include several other dermatological conditions. White fibrous papulosis of the neck (WFPN) is one such condition, characterized by slightly increased and thickened collagen fibers in the papillary dermis, accompanied by normal or decreased elastic fibers. WFPN primarily affects older individuals and is associated with skin aging. Dermoscopic features of WFPN include homogeneous, white, well-circumscribed lesions punctuated with dotted, short, or thin vessels, which differ from the dermoscopic appearance of PE.
Another differential diagnosis is dermatofibroma, which typically presents with a delicate peripheral pigmented network and a central white network on dermoscopy. Other conditions to consider include papular acne scars, anetoderma, mid-dermal elastolysis, and postinflammatory elastolysis. Each of these conditions has distinct clinical and histopathological features that help differentiate them from PE.
Role of Dermoscopy in Diagnosis
Dermoscopy is a non-invasive diagnostic tool that can aid in the diagnosis and differential diagnosis of various dermatoses. In the case of PE, dermoscopy revealed unique features, including a honeycomb-like reticular pigment pattern surrounded by radial pigment, without any vascular involvement. These dermoscopic characteristics can help clinicians distinguish PE from other similar conditions, thereby guiding appropriate management and treatment.
Conclusion
Papular elastorrhexis is a rare dermatological condition that often goes undiagnosed due to its nonspecific clinical presentation. The case presented here highlights the importance of dermoscopy in the diagnostic process, as it revealed unique features that are not commonly associated with other conditions. Histopathological analysis remains the gold standard for confirming the diagnosis of PE, showing reduced, fragmented, or absent elastic fibers in the dermis. Surgical removal of the lesion appears to be an effective treatment option, with no recurrence observed in this case during the one-year follow-up period.
Understanding the clinical, dermoscopic, and histopathological features of PE is crucial for accurate diagnosis and management. Further research is needed to elucidate the underlying etiology and pathogenesis of this rare condition, which may lead to more targeted and effective treatment options in the future.
doi.org/10.1097/CM9.0000000000001280
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