Papular elastorrhexis: a rare acquired elastic tissue disease

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Matthew Ladda
Patrick Fleming



Background: papular elastorrhexis is a rare, acquired disorder of elastic tissue. The etiology of papular elastorrhexis is currently unknown, and few cases have been reported in the literature since the condition was first described in 1987. Papular elastorrhexis is clinically characterized by multiple small asymptomatic white or flesh coloured papules predominately located on the trunk and proximal extremities. Initial lesions are usually detected in the first two decades of life, and the condition has been reported more frequently in females. We present a case of a patient with papular elastorrhexis on her neck.

Case Presentation: a healthy Caucasian female in her 30s presented with a four-year history of asymptomatic 0.5mm white papules on her lateral neck. She had no history of inflammation, acne, or trauma to the area, and had no family history of similar lesions. A full body skin exam was completed and was otherwise unremarkable. A punch biopsy was taken of the lesions on the lateral neck and sent for histopathological examination. Hematoxylin and eosin stains were normal, however, elastic stain showed a focal absence of elastic fibers in the papillary dermis and normal fibers in the reticular dermis consistent with a diagnosis of papular elastorrhexis.

Conclusion: the diagnosis of papular elastorrhexis is made based on both clinical and histopathological characteristics. The differential diagnosis of papular elastorrhexis includes papular acne scars, nevus anelasticus, Buschke Ollendorff syndrome, mid-dermal elastolysis, eruptive collagenoma, and pseudoxanthoma elasticum. Papular elastorrhexis is a benign condition, but cosmetic concerns may be significant in some cases. Unfortunately, given the rarity of this condition, no rigorous data exist supporting the use of a particular treatment. Knowledge of the key and distinguishing features of papular elastorrhexis, as highlighted in this case, is critical to accurately diagnose this rare condition.