Dermatology: Practical and Conceptual


Dermatology Practical & Conceptual

Letter  |  Dermatol Pract Concept. 2021;11(3):e 2021064 1

The Role of Dermoscopy in Diagnosis: A Case 
Presentation of Pseudoxanthoma Elasticum Initially 

Misdiagnosed as Pigmented Contact Dermatitis
Ömer Faruk Elmas1, Abdullah Demirbaş2, Raşit Kılıç3, Asuman Kilitçi4

1 Department of Dermatology, Kırıkkale University, Kırıkkale, Turkey

2 Department of Dermatology, Evliya Çelebi Training and Research Hospital, Kütahya Health Sciences University, Kütahya, Turkey

3 Department of Ophthalmology, Tokat Gaziosmanpaşa Unıversity, Tokat, Turkey
4 Department of Pathology, Kırşehir Ahi Evran University, Kırşehir, Turkey

Key words: pseudoxanthoma elasticum, pigmented contact dermatitis, dermoscopy

Citation: Elmas ÖF, Demirbaş A, Kılıç R, Kilitçi A. The Role of Dermoscopy in Diagnosis: A Case Presentation of Pseudoxanthoma 
Elasticum Initially Misdiagnosed as Pigmented Contact Dermatitis. Dermatol Pract Concept. 2021;11(3):e 2021064.  
DOI: https://doi.org/10.5826/dpc.1103a64

Accepted: November 20, 2020; Published: July 8, 2021

Copyright: ©2021 Elmas et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License BY-
NC-4.0, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors and 
source are credited.

Funding: None.

Competing interests: The authors have no conflicts of interest to disclose.

Authorship: All authors have contributed significantly to this publication.

Corresponding author: Ömer Faruk Elmas, Associate Professor, Department of Dermatology, Kırıkkale University, Kırıkkale , Turkey. 
Email: omerfarukmd@gmail.com

Case Presentation

A 45-year-old female with a three-year history of bilateral 

ocular angioid streaks was referred to our dermatology 

department Kırşehir Ahi Evran University for the evalua-
tion of persistent cutaneous lesions, present since childhood 

(Figure 1, A-D). The patient was previously diagnosed with 

pigmented contact dermatitis 5 years ago, in a different 

dermatology outpatient clinic. Dermatological examination 

in our dermatology department showed confluent yellowish 

papules on both sides of the neck (Figure 2A). Dermoscopic 

examination revealed reticulated yellow-to-white clods on a 

light red background, along with defocused linear irregular 

vessels (Figure 2B). Histopathological examination showed 

mild epidermal atrophy, accumulation of swollen clumped 

fibers, mild inflammatory cell infiltration, and dilated dermal 

vessels (Figure 2C). Elastic van Gieson staining showed frag-

mented elastic fibers. Based on the clinical, dermoscopic and 

histopathological features, a diagnosis of pseudoxanthoma 

elasticum was made. Detailed imaging studies showed no 

systemic involvement except for ocular lesions.

Teaching Point

Pseudoxanthoma elasticum has a peculiar dermoscopic 

pattern composed of coalescing and reticulated yellow clods 

on a light red background [1,2]. A thorough dermoscopic 



2 Letter  |  Dermatol Pract Concept. 2021;11(3):e 2021064

Figure 1. Color fundus photographs. (A, B) Angioid streaks in both eyes (white arrows). (C, D) Angioid streaks in fundus autofluorescence 

and red free images of the left eye (white arrows).

Figure 2. Dermatologic, dermoscopic, and histopathologic examination. (A) Dermatological exam-

ination showed confluent yellowish papules on the neck. (B) Dermoscopic examination revealed retic-

ulated yellow-to-white clods on a light red background, along with disfocused linear irregular vessels. 

(C) Histopathological examination showing dermal accumulation of swollen clumped fibers. 



Letter  |  Dermatol Pract Concept. 2021;11(3):e 2021064 3

examination may prevent misdiagnosis especially in those 

cases characterized by subtle cutaneous manifestations.

References

1. Kawashima S, Togawa Y, Miyachi H, Matsue H. Dermoscop-

ic features of pseudoxanthoma elasticum. Clin Exp Derma-

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29271496

2. Persechino F, Giordano D, Marini CD, Franceschini C, Ardigò 

M, Persechino S. Dermoscopy, Optical Coherence Tomography, 

and Histological Correlation of Pseudoxanthoma Elasticum. 

Dermatol Pract Concep. 2019;9(3):209–210. DOI: 10.5826/

dpc.0903a07. PMID: 31384495