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Elastosis perforans serpiginosa induced by d ‐penicillamine treated with cyclosporine and allopurinol
Author(s) -
ValenzuelaUbiña Sandra,
JiménezGallo David,
Russode la Torre Francisco,
LinaresBarrios Mario
Publication year - 2020
Publication title -
dermatologic therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.595
H-Index - 68
eISSN - 1529-8019
pISSN - 1396-0296
DOI - 10.1111/dth.13692
Subject(s) - medicine , penicillamine , dermatology , photodynamic therapy , cryotherapy , drug , ciclosporin , pharmacology , surgery , chemotherapy , chemistry , organic chemistry
Elastosis perforans serpiginosa (EPS) is a rare condition within the group of perforating dermatoses. It is characterized by the synthesis of anomalous elastic fibers that are eliminated through perforating channels (transepidermal elimination). It is classified into three subtypes. One of them is drug‐induced by prolonged treatment with d ‐penicillamine. This drug is a heavy metal chelator used to treat diseases such as rheumatoid arthritis, cystinuria, and Wilson's disease. Years of treatment with d ‐penicillamine at high doses are required for developing EPS, with occasional slow regression after drug withdrawal. There is no established treatment for EPS, with described cases using various treatment options such as corticoids, retinoids, tazarotene, cryotherapy, imiquimod, photodynamic therapy, electrosurgery, and CO2 laser among others with inconsistent results. We present a case of EPS induced by d ‐penicillamine with favorable response to cyclosporine and allopurinol in a patient with a history of Wilson's disease since childhood. They maybe considered as possible therapeutic options not described so far for an entity with variable response to current treatments. We highlight the extensive involvement of the case with progression, despite the suspension of d ‐penicillamine and failure to previous treatments with photodynamic therapy and retinoids.