What are the other Names for this Condition? (Also known as/Synonyms)

• Drug-Induced EPS
• Medication-Induced EPS
• Medication-Induced Elastosis Perforans Serpiginosa

What is Drug-Induced Elastosis Perforans Serpiginosa? (Definition/Background Information)

• Elastosis Perforans Serpiginosa (EPS) is a rare skin disorder seen during adulthood. In this abnormal condition, elastic fibers come out of (extrude from) the epidermis of skin. There are 3 types of EPS: Idiopathic, Reactive, and Drug-Induced form
• In Drug-Induced Elastosis Perforans Serpiginosa, the skin condition occurs as a side effect of certain medication, such as pencillamine
• Drug-Induced EPS is characterized by the presence of multiple tiny papules on the neck or face in a winding pattern. The skin lesions are usually itchy
• Stopping or discontinuing the use of such medications (creams) may cure the condition or decrease progression of the drug-induced form of EPS. Additionally, the treatment may involve vitamin A therapy, antihistamine, and moisturizing creams
• The prognosis of Drug-Induced Elastosis Perforans Serpiginosa is good with appropriate treatment and stoppage of the causative drug

Who gets Drug-Induced Elastosis Perforans Serpiginosa? (Age and Sex Distribution)

• Drug-Induced Elastosis Perforans Serpiginosa is a skin condition caused by certain medications (that are administered for other underlying conditions). Hence, any individual of any age may be at risk
• Both males and females are affected
• There is no known racial, ethnic, or geographical preference

What are the Risk Factors for Drug-Induced Elastosis Perforans Serpiginosa? (Predisposing Factors)

• The key risk factor for Drug-Induced Elastosis Perforans Serpiginosa is the use of pencillamine drug, which causes the skin condition as a side effect

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Drug-Induced Elastosis Perforans Serpiginosa? (Etiology)

• The exact cause of Drug-Induced Elastosis Perforans Serpiginosa formation is unknown
• The condition can be defined as an adverse reaction of the body to certain medications that are used for other health conditions. This results in the formation of lesions on the skin and other signs and symptoms

What are the Signs and Symptoms of Drug-Induced Elastosis Perforans Serpiginosa?

The signs and symptoms of Drug-Induced Elastosis Perforans Serpiginosa may include:

• The presence of multiple, 2-6 mm sized skin papules in a snake-like pattern; there may be a central keratotic plug observed among the collection of papules
• In this condition, elastic fibers extrude from the skin surface of the lesions
• The lesions are usually itchy
• The affected area includes the head and neck region, especially the neck and face. The arms and legs may be affected too
• The condition may be bilateral i.e., both sides of the body are affected

The severity of the signs and symptoms may be related to usage of the drug and drug dosage.

How is Drug-Induced Elastosis Perforans Serpiginosa Diagnosed?

The following are the diagnostic methods that may be used for Drug-Induced Elastosis Perforans Serpiginosa:

• A thorough physical examination and a complete medical history (which includes the use of any drugs, topical applications, or creams) are very crucial
• Dermoscopy: Dermoscopy is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• A diagnosis of Drug-Induced EPS may be arrived at clinically by analyzing the signs and symptoms and evaluation of medical history. A skin biopsy is usually not needed
• Skin biopsy: A skin biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Drug-Induced Elastosis Perforans Serpiginosa?

The complications due to Drug-Induced Elastosis Perforans Serpiginosa may include:

• It can lead to self-image issues, emotional and psychological stress
• Bacterial and fungal infections: Due to continuous itching and scaling of the skin, it can result in prolonged moist skin, which provides a suitable environment for bacteria and fungi to grow and thrive

How is Drug-Induced Elastosis Perforans Serpiginosa Treated?

Discontinuing the drug (D-pencillamine) responsible for the side effect may result in a cure, or in improvement of the condition. Other treatment measures that may be considered include:

• Vitamin A therapy
• Phototherapy - the use of light to treat the skin condition
• Use of moisturizing creams
• Antihistamines to help with itching
• For mild skin conditions, self-care measures are recommended, such as washing with mild (antibacterial) soap and applying warm compress
• Reassurance may be provided in case of emotional stress

Follow-up care with regular screening and checkups are important.

A few self-care tips and home remedies for EPS may include:

• Completely avoid scratching the affected areas
• A comfortable, cool bath may help soothe the skin; but, avoid excessive washing and scrubbing of the skin
• Wear smooth cotton clothes
• Use only mild perfumes, soaps, and detergents
• Keeping the skin moist can help in reducing the signs and symptoms

How can Drug-Induced Elastosis Perforans Serpiginosa be Prevented?

• Currently, there are no specific methods or guidelines to prevent Drug-Induced Elastosis Perforans Serpiginosa
• The drug that caused the condition may be discontinued or alternative medications used

What is the Prognosis of Drug-Induced Elastosis Perforans Serpiginosa? (Outcomes/Resolutions)

• The prognosis of Drug-Induced Elastosis Perforans Serpiginosa is generally good on discontinuation of the offending drug, followed by adequate treatment
• Regular follow up visits with the healthcare providers are important

Additional and Relevant Useful Information for Drug-Induced Elastosis Perforans Serpiginosa:

• There is no evidence to prove that oily foods and chocolate-based products have an influence on Elastosis Perforans Serpiginosa
• Cleaning the skin too hard with strong chemicals or soaps may aggravate the skin condition. Care must be taken avoid strong soaps and chemicals that could potentially worsen the condition
• The presence of dirt on the body is not a causative factor. However, it helps to be clean and hygienic, which will help the condition from getting worse