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Examination showed agminated lesions forming cobblestone-like plaques. The patient had no systemic symptoms and only a long history of hair dye exposure. A 4-mm punch biopsy with hematoxylin-eosin and special staining demonstrated loss of elastic fibers in the papillary dermis on Shikata staining without calcification, supporting PXE-like papillary dermal elastolysis (PXE-PDE).",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/a-curious-case-of-cutaneous-elastolysis-grand-rounds-case-discussion/443189/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/a-curious-case-of-cutaneous-elastolysis-grand-rounds-case-discussion/443189.png","ImageObject",300,407,{"name":92,"@type":93},"Olivia Brown","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-02","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":81},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What dermatologic diagnosis best fits the case presentation?","Question",{"text":112,"@type":113},"PXE-like papillary dermal elastolysis (PXE-PDE) best fits the distribution and histology, with papillary dermal elastic fiber loss and no systemic involvement.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"Which histologic feature distinguishes PXE-PDE from inherited pseudoxanthoma elasticum (PXE)?",{"text":117,"@type":113},"Calcification of elastic fibers distinguishes PXE; PXE-PDE shows elastolysis without calcification.",{"name":119,"@type":110,"acceptedAnswer":120},"Is PXE-PDE associated with systemic disease, and does it require cardiovascular workup?",{"text":121,"@type":113},"PXE-PDE is described as an acquired cutaneous condition with no systemic involvement, so cardiovascular workup for systemic assessment is not required in this context.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},443189,1790822748,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":81,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":81,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":39},16904993612988,"https://ap-avatar.wpscdn.com/davatar_a8503ba1806abce46bf441b54a3ca4cd","GRAND ROUNDS  \nA curious case of cutaneous elastolysis  \nRobert J. Vanaria, BS,a Claudia Green, DO,b and Allen Sapadin, MDb  \nFig 1. Asymptomatic-to-mildly pruritic skin lesions on the posterior neck and axillae.  \nCASE DESCRIPTION  \nA 76-year-old woman with no significant medical history presented with asymptomatic-to-mildly pruritic skin lesions on the back of neck and axillae (Fig 1), present for approximately 6 months. Physical examination revealed agminated yellow-white papules and nodules forming cobblestone-like plaques. The patient denied visual changes, hemoptysis , hematochezia, or cardiac symptoms. Her only notable history was hair dye use over 4 decades. A 4-mm punch biopsy from the right side of the back of the neck was collected for hematoxylin and eosin staining.  \nCLINICAL QUESTIONS  \nQuestion 1: What is the most likely diagnosis?  \nA. Pseudoxanthoma elasticum (PXE)  \nB. PXE-like papillary dermal elastolysis (PXE-PDE)  \nC. Mid-dermal elastolysis  \nD. White fibrous papulosis of the neck  \nE. Papular elastorrhexis  \nFrom the Hackensack Meridian School of Medicine, Nutley, New Jerseya; and Department of Dermatology, Hackensack Univer  \nsity Medical Center-Palisades, North Bergen, New Jersey.b Funding sources: None.  \nPatient consent: The authors attest that they have obtained written consent from patient/s, their legal guardian/s or person/s with legal authority, for their photographs and medical information to be published in print and online and with the understanding that this information may be publicly available. Patient consent forms were not provided to the journal but are retained by the authors to be made available upon request.  \nIRB approval status: Not applicable.  \nCorrespondence to: Claudia Green, DO, Department of Dermatology, Hackensack University Medical Center-Palisades, 7600 River Rd, North Bergen, NJ 07047. E-mail: [claudia.green@](claudia.green@)[ ](claudia.green@)[hmhn.org](hmhn.org).  \nJAAD Case Reports 2026;67:185-7 .  \n2352-5126  \n© 2025 The Author(s) . Published by Elsevier Inc. on behalf of the American Academy of Dermatology, Inc. This is an open access article under the CC BY license ([http://creativecommons.org/](http://creativecommons.org/)[ ](http://creativecommons.org/)[licenses/by/4.0/](licenses/by/4.0/)) .  \n[https://doi.org/10.1016/j.jdcr.2025.09.037](https://doi.org/10.1016/j.jdcr.2025.09.037)  \n186 Vanaria, Green, and Sapadin JAAD CASE REPORTS JANUARY 2026  \nAnswers:  \nA. Pseudoxanthoma elasticum (PXE)—Incorrect. PXE is an inherited disorder that presents in childhood and adolescence with similar skin findings but has systemic features (retinal angioid streaks, gastrointestinal bleeding, and coronary artery disease) . Histology shows calcified elastic fibers.  \nB. PXE-like papillary dermal elastolysis (PXE-PDE)—Correct. Characterized by yellow-white papules on the neck and axillae, often asymptomatic, occasionally pruritic. Biopsy: papillary dermal elastic fiber loss on Shikata, no calcification. No systemic involvement, unlike PXE.1  \nC. Mid-dermal elastolysis — Incorrect. Presents with fine wrinkling or perifollicular papules on trunk or arms from loss of elastic fibers in the mid dermis.  \nD. White fibrous papulosis of the neck — Incorrect. Resembles PXE-PDE but shows collagen thickening on histology. Lesions are firm, white papules on the lateral aspect of the neck, lacking yellow hue or cobblestone pattern.  \nE. Papular elastorrhexis — Incorrect. Occurs in children or young adults with hypopigmented papules on trunk or extremities. Histology shows elastolysis but without cobblestone appearance or classic PXE-PDE distribution.  \nQuestion 2: Which of the following histologic features best distinguishes PXE-PDE from PXE?  \nA. Calcification of elastic fibers  \nB. Collagen thickening in the papillary dermis  \nC. Loss of elastic fibers in the mid dermis  \nD. Presence of dermal mucin  \nE. Fragmentation of elastic fibers without calcification Answers:  \nA. Calcification of elasti","cbCaikDMRnhHDe3a","https://ap.wps.com/l/cbCaikDMRnhHDe3a","pdf",2993071,"English","# Case Description\n## Clinical Questions\n## Answers\n## Discussion","[{\"question\":\"What dermatologic diagnosis best fits the case presentation?\",\"answer\":\"PXE-like papillary dermal elastolysis (PXE-PDE) best fits the distribution and histology, with papillary dermal elastic fiber loss and no systemic involvement.\"},{\"question\":\"Which histologic feature distinguishes PXE-PDE from inherited pseudoxanthoma elasticum (PXE)?\",\"answer\":\"Calcification of elastic fibers distinguishes PXE; PXE-PDE shows elastolysis without calcification.\"},{\"question\":\"Is PXE-PDE associated with systemic disease, and does it require cardiovascular workup?\",\"answer\":\"PXE-PDE is described as an acquired cutaneous condition with no systemic involvement, so cardiovascular workup for systemic assessment is not required in this context.\"}]","A curious case of cutaneous elastolysis - Grand Rounds - Case Discussion | PDF",1790703234]