Presenter: Mary Veremis-Ley DO and Michelle Endicott DO

Dermatology Program: University Hospitals of Cleveland-Richmond Heights

Program Director: Monte Fox, D.O.

Submitted on: April 30, 2003

CHIEF COMPLAINT:  Redundant skin around his neck with a yellow discoloration

CLINICAL HISTORY: Patient came to the office complaining of redundant skin around his neck with a yellow discoloration. On a review of systems, the patient admits to having had a number of laser surgeries to his eyes and has been legally blind since 1996. He reports his sister has similar problems with her eyes but her neck is normal in appearance. Upon further questioning, the patient states he underwent triple bypass surgery two years ago.

PHYSICAL EXAM:
The patient’s neck bilaterally has multiple, confluent yellow-colored papules.

LABORATORY TESTS:

Elevated cholesterol

DERMATOHISTOPATHOLOGY:

Microscopic description: The epidermis is normal and a grenz zone was noted. Fragmented, swollen, and irregularly clumped basophilic fibers are present in the middle and lower thirds of the dermis. The abnormal elastic fibers stain with routine hematoxylin-eosin because of calcium uptake by the fibers.

DIFFERENTIAL DIAGNOSIS:

1.   Solar elastosis
2.   Cutis Laxa
3.   Pseudoxanthoma elasticum
4.   Ehlers-Danlos Syndrome
5.   Perforating calcific elastosis