Dermatology: Practical and Conceptual


Image Letter  |  Dermatol Pract Concept 2019;9(3):7 209

Dermatology Practical & Conceptual

Case Presentation

We propose the case of a 17-year-old female patient with 

multiple, soft, yellowish papules symmetrically distributed 

on the neck (Figure 1A). Dermoscopy showed a yellowish 

orange area associated with reddish and whitish areas [1] 

(Figure 1B). Optical coherence tomography (OCT) revealed 

normal epidermis associated with clusters of horizontally 

oriented dermal aggregates with peripheral clefts (Figure 1C). 

A biopsy was performed in the same site of previous nonin-

vasive imaging techniques. Histology disclosed the presence 

of altered elastic fibers in the upper and reticular dermis with 

extension to the papillary dermis stained with hematoxylin 

and eosin (Figure 1D). Pseudoxanthoma elasticum (PXE) is 

a rare disorder concerning elastolytic fibers due to a genetic 

mutation, with systemic alterations as mainly cardiac and 

ophthalmological complications due to abnormalities of 

elastic fibers.

Teaching Point

We believe that this is the first report of PXE with dermos-

copy correlated to OCT and histology. OCT may be useful for 

PXE confirmation showing specific dermal features.

Reference

1. Nasca MR, Lacarubba F, Caltabiano R, Verzi AE, Micali G. 

Perforating pseudoxanthoma elasticum with secondary elasto-

sis perforans serpiginosa-like changes: dermoscopy, confocal 

microscopy and histopathological correlation. J Cutan Pathol. 

2016;43(11):1021-1024.

Dermoscopy, Optical Coherence Tomography,  
and Histological Correlation of  

Pseudoxanthoma Elasticum
Flavia Persechino1,2, Domenico Giordano3, Chiara D. Marini4, Chiara Franceschini2,  

Marco Ardigò2, Severino Persechino3

1 Department of Clinical and Molecular Medicine, Sapienza University of Rome, Italy

2 Clinical Dermatology, San Gallicano Dermatological Institute, IRCCS, Rome, Italy

3 NESMOS Department, Dermatology Unit, Sant’Andrea Hospital Faculty of Medicine & Department of Psychology, Sapienza University of 

Rome, Italy

4 Surgical Pathology Units, Department of Clinical and Molecular Medicine, Ospedale Sant’Andrea, Sapienza University of Rome, Italy

Key words: dermoscopy, pseudoxanthoma elasticum, optical coherence tomography, histology, elastic fibers

Citation: Persechino F, Giordano D, Marini CD, Franceschini C, Ardigò M, Persechino S. Dermoscopy, optical coherence tomography, 
and histological correlation of pseudoxanthoma elasticum. Dermatol Pract Concept. 2019;9(3):209-210. DOI: https://doi.org/10.5826/
dpc.0903a07

Accepted: April 25, 2019; Published: July 31, 2019

Copyright: ©2019 Persechino et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, 
which permits unrestricted use, distribution, and reproduction in any medium, provided the original author 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: Severino Persechino, MD, NESMOS Department, Dermatology Unit, Sant’Andrea Hospital Faculty of Medicine 
& Department of Psychology, Sapienza University of Rome, Via di Grottarossa, 1035, 00189 Rome, Italy. Email: severino.persechino@
uniroma1.it



210 Image Letter  |  Dermatol Pract Concept 2019;9(3):7

Figure 1. (A) Clinical photograph of PXE. (B) Dermoscopy of PXE. (C) OCT revealed normal epidermis associated with clusters of horizon-

tally oriented dermal aggregates with peripheral clefts. (D) Histology disclosed the presence of altered elastic fibers in the upper and reticular 

dermis with extension to the papillary dermis stained with hematoxylin and eosin. [Copyright: ©2019 Persechino et al.]

A

B

D

C