PMC6464679_01
Pre- and post-treatment photos of elastosis perforans serpiginosa (axilla)
asm-1-56f1.jpg
PMC6464679_01_asm-1-56f1.jpg
f1-asm-1-56
The skin over both the axillae was wrinkled, yellowish, waxy and hyperextensible, resembling plucked chicken skin with similar findings over the back of his neck (Figure 1 and 2). Examination at that time showed multiple erythematous to brownish umbilicated papules coalescing into annular and arciform plaques over the axillae, neck, elbows and buttocks (Figure 1 and 2). He started improving within three weeks of starting the treatment and at nine weeks he had >95% improvement with almost total clearance of his lesions (Figures 1 and 2) and the dose was decreased to 25mg/day.
Pre- and post-treatment photos of elastosis perforans serpiginosa (neck).
asm-1-56f2.jpg
PMC6464679_01_asm-1-56f2.jpg
f2-asm-1-56
The skin over both the axillae was wrinkled, yellowish, waxy and hyperextensible, resembling plucked chicken skin with similar findings over the back of his neck (Figure 1 and 2). Examination at that time showed multiple erythematous to brownish umbilicated papules coalescing into annular and arciform plaques over the axillae, neck, elbows and buttocks (Figure 1 and 2). He started improving within three weeks of starting the treatment and at nine weeks he had >95% improvement with almost total clearance of his lesions (Figures 1 and 2) and the dose was decreased to 25mg/day.
Elastic-Van Gieson stain of the skin biopsy from the right axillary fold. A) clumped and fragmented elastic fibers throughout the reticular dermis (50x). B) high magnification with a frayed pattern and serrated border (400x).
asm-1-56f3.jpg
PMC6464679_01_asm-1-56f3.jpg
f3-asm-1-56
Elastic-Van Gieson (EVG) stain revealed clumped and fragmented elastic fibers throughout the reticular dermis, many of which exhibited a frayed pattern with a serrated border (bramble-bush) (Figure 3A and 3B).
Skin biopsy from the neck papules. A) aggregating short and fragmented eosinophilic elastic fibers, associated with multinucleated histiocytic giant cell inflammatory reaction (200x). B) Elastic-Van Gieson stain revealing focal transepidermal elimination of elastic fibres (200x).
asm-1-56f4.jpg
PMC6464679_01_asm-1-56f4.jpg
f4-asm-1-56
In the biopsy from the neck papules, short and fragmented eosinophilic fibers were observed in the dermis, focally aggregating and associated with multinucleated histiocytic giant cell inflammatory reaction, (Figure 4A). EVG stain demonstrated altered elastic fibres in a pattern similar to that seen in the right axillary fold biopsy, but in addition, focal transepidermal elimination of elastic fibres was observed (Figure 4B).