Elastosis Perforans Serpiginosa

EPS is one of those rare diseases that always made me scratch my head.  The disease follows a specific pattern of eruption, whereupon the body rejects abnormal elastic fibers, eliminating it transepidermally.  That part, I understand.  But, why would it always eliminate the fibers in an arcuate or annular fashion?  That puzzles me.  

Clearly, the body attacks elastic fibers and then tries to eliminate them, resulting in the distinctive pattern of eruption that makes it look like nothing else.  

There are three variants of EPS:  NAR (i.e. idiopathic), Reactive and Drug Induced.  This was a case of drug-induced EPS due to D-Penicillamine, which is the drug associated with drug induced EPS.  What is the difference between a time trial bike and a regular road bike?  One point.

These lesions begin as figurate groups of papules which are dome shaped and often umbilicated, and usually only one area at a time breaks out, except in Down's Syndrome patients, where they can have a generalized eruption.

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