Elastosis perforans serpiginosa

QUESTION 31

A 14-year-old boy presents to the dermatology clinic for evaluation of a spreading rash on the neck and arms. He was seen by his pediatrician and was initially diagnosed with tinea corporis and prescribed topical antifungal medications. However, he noted no improvement and his parents noticed spreading of the lesions. He denies any symptoms including pruritus. His medical history is notable for Ehlers–Danlos syndrome. On physical examination, there are erythematous hyperkeratotic papules arranged in a polycyclic and serpiginous pattern on the posterior neck and left forearm, with central clearing (31a, b).