Tazarotene is an effective therapy for elastosis perforans serpiginosa.

A 22-year-old woman presented with a 2-year history of an eruption on the anterior aspect of her neck and right arm that was relatively asymptomatic. She had a history of cystinuria, which had been treated with D-penicillamine for several years, but the D-penicillamine therapy had been discontinued 2 years before the onset of the eruption. A biopsy was performed approximately 1 year before her presentation to our institution. The biopsy specimen demonstrated clawlike downgrowths of epidermis surrounding collections of amorphous basophilic debris and hyperplastic elastic fibers. Many elastic fibers were noted to be pushing through epidermal channels (Figure 1), a finding that was consistent with the clinical diagnosis of elastosis perforans serpiginosa (EPS). The patient was treated unsuccessfully with several modalities in a sequential fashion, including liquid nitrogen cryotherapy monthly for 6 months, topical tretinoin gel nightly for 2 months, oral isotretinoin at dosages ranging from 40 to 60 mg/d for 15 weeks, and 2 sessions of carbon dioxide laser surgery. On physical examination, she was noted to have erythematous annular and arcuate keratotic plaques on the anterior aspect of her neck and right arm (Figure 2).