d-Penicillamine induced elastosis perforans serpiginosa with involvement of glans penis

• Main Authors: Yao-Nien Chuang, Chun-An Yao, Tsu-Man Chiu, Kuo-Chia Yang, Yueh-Min Lin, Hsiu-Cheng Hsu
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2014-06-01
• Series: Dermatologica Sinica
• Subjects: d-penicillamine; elastosis perforans serpiginosa; glans penis; Wilson disease
• Online Access: http://www.sciencedirect.com/science/article/pii/S102781171300058X

Elastosis perforans serpiginosa (EPS) is an unusual perforating disorder characterized by extrusion of altered elastic fibers through the epidermis. Clinically, it presents as keratotic papules with a tendency for serpiginous or annular distribution that most commonly involves the sides of the neck and the back. However, involvement of the penis has rarely been reported. We present a case of EPS involving the neck, axilla, and glans penis in a 42-year-old man who had received long-term d-penicillamine treatment for Wilson disease. Skin biopsy revealed perforating channels containing numerous altered elastic fibers, with a characteristic “bramble brush” or “lumpy-bumpy” appearance as demonstrated by an elastin stain. The latter is thought to be pathognomonic for penicillamine-induced degenerative elastosis. These degenerative changes occurring in glans penis have rarely been described in the literature. Prompt recognition of the rare presentation could lead to early discontinuation of the offending drug, to prevent further sequelae.