Papular Elastorrhexis: DISCUSSION

14 Jan

Papular elastorrhexis (PE) is a rare condition, characterized by asymptomatic papules and fragmen­tation of dermal elastic fibers. In 1987 Bordas et al. described the first case of papular elastorrhexis which consisted of several small yellowish papules on the trunk. It was thought to be a variant of nevus an- elasticus due to the reduction and fragmentation of elastic tissue. Sears et al. suggested that this disorder represented a variant of a connective tissue nevi.

Schirren et al. suggested that PE was a mild form of Buschke-Ollendorff syndrome because familiar PE had been described. In 2002, Choonhakarn et al. described the distinct and repeatable features that are seen in reported cases of PE, and proposed that PE is a distinct variant of elastic tissue nevi, not an incomplete form of Buschke-Ollendorff syndrome. However, recently there has been no convincing data to support the theory that PE is a variant of connective tissue nevus. Therefore PE appears to be a distinct entity that occurs in adolescence as tiny, white, asymptomatic papules scattered over the torso, with no predilection of the follicular areas and no tendency to group into plaques. In histo­pathologic examination, the papules demonstrate decreased and fragmented elastic fibers within the reticular dermis. Collagen bundles can be thickened and homogenized, or normal. Some of the cases show a perivascular infiltrate of lymphocytes and histiocytes in the superficial and deep dermis. Apcalis Oral Jelly

Because of the decrease and alterations in the elastic fibers, several connective tissue nevus variants or secondary scarring must be considered in the differential diagnosis of PE. Postacne scars or secondary scarring may appear clinically similar but are usually characterized by follicular papules with a marked decrease of elastic fibers surrounding hair follicles and a laminated arrangement of collagen, whereas PE is classically characterized by nonfolli- cular papules with elastorrhexis, not elastolysis. Moreover our case had no history of prior trauma or acne. Eruptive collagenoma consists of multiple, asymptomatic papules that histologically shows a typically thickening and homogenization of collagen fibers, and a decrease or degenerative change of elastic fibers that seems to be secondary to increasing collagen fiber. Nevus anelasticus is a congenital disorder with follicular papules that are grouped into patches. Although this disorder shows a decrease in the elastic fibers without changes of collagen in the lesion, it differs significantly from PE, clinically. PE appears in adolescence and papules tend to be nonfollicular, evenly scattered over the affected areas, and do not tend to coalesce.

The paucity of reports on PE and the limited details provided in several of these make it im­possible to determine whether PE could be associated with pruritus. However, other probable cutaneous conditions were ruled out and the significant factor provoking pruritus was not found. We describe a case of “PE with itching sensation” which presented clinically as typical, multiple, white nonfollicular papules on the back, and histologically as fragmented elastic fibers in the reticular dermis which was consistent with papular elastorrhexis.