Papular elastorrhexis: clinical perspectives

Abstract

First described by Bordas in 1987, papular elastorrhexis (PE) is a rare elastic fiber disorder of the skin characterized by multiple, discrete, asymptomatic, firm, nonfollicular, monomorphous, 1–5 mm, circumscribed, hypopigmented, oval to round papules, symmetrically distributed on the chest, abdomen, back, shoulders, arms, and thighs. The onset of the condition is usually in the first or second decade of life. PE appears to be an exceedingly rare entity, with 33 cases reported in the literature until now. However, the disorder might be underestimated probably because of its subtlety, asymptomatic course, and benign nature of clinical alterations, which can easily be confused with other dermatoses such as acne scars. Clinical and histopathological differential diagnosis of PE is broad and includes papular acne scars, eruptive collagenoma, disseminated lenticular dermatofibrosis (as a component of Buschke–Ollendorff syndrome), white fibrous papulosis of the neck, pseudoxanthoma elasticum, pseudoxanthoma elasticum-like papillary dermal elastolysis, middermal elastolysis, and perifollicular elastolysis. Treatment of PE is a matter of debate and no reliable curative option exists.

Dermoscopy of papular elastorrhexis

“…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.…”

A Case of Facial Papular Elastorrhexis

“…PE is a rare acquired elastolytic skin disorder with a skeptical etiopathogenesis. 1 It is mostly considered to be a non-familial disorder, while an isolated case of familial clustering has been reported. 1 , 5 Therefore, both acquired and familial forms of PE were believed to be existed.…”

“…The lesions usually localize on the trunk and extremities. 1 To date, only 2 cases with facial involvement have been reported. 2 , 3 The histopathologic features of PE are fragmentation and focal absence of elastic fibers, while the changes of collagen fibers are inconsistencies.…”

“… 2 , 3 The histopathologic features of PE are fragmentation and focal absence of elastic fibers, while the changes of collagen fibers are inconsistencies. 1 , 4 In this report, we would like to present the first case of facial PE in China and to demonstrate, for the first time, changes in collagen fibers in PE lesions using Masson staining.…”

White fibrous papulosis of the neck: A case report

“…6 Histopathologically focal increase and thickening of collagen fibers in the papillary dermis and also loss of elastic fibers demonstrated. 7 It has clinically and histopathologically similar features with pseudoxanthoma elasticum, pseudoxanthoma elasticum-like papillary dermal elastosis, mid-dermal elastosis, and papular elastorrhexis 6,8 (Table 1). The dermoscopic examination revealed clearly circumscribed, homogenous white areas, dotted or short thin vessels without follicular involvement.…”