Medical Care
Little medical treatment is required for elastosis perforans serpiginosa (EPS), except to monitor for internal vascular complications.
Although many medications have been tried, no uniformly effective medications have been reported. A few reports suggest benefit from isotretinoin, but little confirmation is available. [13] A 2002 report described effective treatment with topical tazarotene 0.1% gel used daily at bedtime after 2 months of treatment in two patients. The lesions were noted to flare upon discontinuation of the therapy. [14] A 2006 case study described imiquimod as an effective treatment after 10 weeks of therapy. [15]
If pruritus is present, symptomatic therapy with camphor-containing and/or menthol-containing products is beneficial.
Photodynamic therapy with aminolevulinic acid reportedly was effective in a case of D-penicillamine–induced elastosis perforans serpiginosa. [16]
Cryotherapy has achieved improvement in some patients. [17, 18]
Surgical Care
Destructive methods appear to do more harm than good, often resulting in scarring worse than that expected from spontaneous healing.
Freezing with liquid nitrogen may have helped several patients. [19] Treatment with some laser techniques may have been modestly helpful in one patient with idiopathic elastosis perforans serpiginosa. [20] Treatment with flashlight pulsed-dye laser appeared to be beneficial in one reported case of elastosis perforans serpiginosa in a patient with Down syndrome. [21] More recently, a patient with elastosis perforans serpiginosa from prolonged therapy with D-penicillamine had complete regression of her lesions using fractional carbon dioxide laser for three sessions over a 6-month period, without resultant scarring. [22]
Activity
Avoid skin irritants.
Long-Term Monitoring
Elastosis perforans serpiginosa typically resolves without complications after a few years.
-
Elastosis perforans serpiginosa in an arciform pattern on nape of neck.
-
Advancing serpiginous arrangement of elastosis perforans serpiginosa papules with mild scarring in their wake.
-
Histologic section of elastosis perforans serpiginosa stained with hematoxylin and eosin. Connective tissue fibers and cellular debris are extruded through the epidermis via a spiraling path.
-
Cross-section of a nidus of fibers and debris of elastosis perforans serpiginosa in transit through the epidermis, stained with hematoxylin and eosin. Elastic fibers are red.
-
Connective tissue and debris of elastosis perforans serpiginosa emerging through the epidermis toward the surface, and elastic fibers in the nearby papillary dermis. The stain is a variation on acid orcein-Giemsa. Elastic fibers are black.
