A Case of Pseudoxanthoma Elasticum

A Case of Pseudoxanthoma Elasticum?

To the Editor: We read with interest the case report by Aksoy and colleagues in the August 2004 issue of Dermatologic Surgery in which a woman with idiopathic calcinosis cutis is presented. 1 Histopathologic examination of excised skin showed granular calcium deposits in the upper and mid–reticular dermis. Despite meticulous evaluation, other abnormal clinical or laboratory findings were not found. We respectfully suggest that both the clinical and histologic images support the diagnosis of pseudoxanthoma elasticum (PXE). Individuals afflicted with PXE present with fleshcolored to yellowish papules coalescing into cobblestoneappearing plaques involving the flexural surfaces of the neck, axillae, abdomen, antecubital fossae, groin, and inner thighs.2 In involved areas, the skin wrinkles and hangs in redundant folds.2,3 Affected areas exhibit the diagnostic findings of clumped, calcified elastic fibers with histopathologic examination. Not unimportantly, these imperfect elastic fibers can lead both to macular degeneration with loss of central vision3 and to calcification of medium- and large-sized

arteries with resultant hypertension, angina pectoris, and intermittent claudication.2 Recently, the specific genetic defect has been discovered on chromosome 16p13.1.3 The characteristic sagging skin folds may lead patients with undiagnosed PXE to our cosmetic doorstep, where we have the opportunity to make both a diagnostic and a therapeutic difference in their lives. MISTY T. SHARP, MD DANIEL A. DAVIS, MD Little Rock, AR

References 1. Aksoy HM, Özdemir R, Karaaslan Ö, et al. Incidental idiopathic calcinosis cutis in a rhytidectomy patient. Dermatol Surg 2004;30:1145–7. 2. Buka R, Wei H, Sapadin A, et al. Pseudoxanthoma elasticum and calcinosis cutis. J Am Acad Dermatol 2000;43:312–5. 3. Hu X, Plomp AS, van Soest S, et al. Pseudoxanthoma elasticum: a clinical, histopathological, and molecular update. Surv Ophthalmol 2003;48:424–38.

© 2005 by the American Society for Dermatologic Surgery, Inc. • Published by BC Decker Inc ISSN: 1076–0512 • Dermatol Surg 2005;31:978.