Elastosis Perforans Serpiginosa Is Not a Cutaneous Manifestation of Marfan Syndrome

Elastosis perforans serpiginosa is a perforating dermatosis that morphologically presents as serpiginous, annular, or curved papules and plaques whose pathologic examination demonstrates the transepidermal elimination of elastic fibers. The perforating dermatosis can be idiopathic or induced by drug exposure: most commonly, D-penicillamine. Occasionally, elastosis perforans serpiginosa is associated with a connective tissue disease. Individuals with Marfan syndrome have a defect in the FBN1 gene, which produces fibrillin. The connective tissue disease can occur spontaneously or is usually inherited in an autosomal dominant manner. Major criteria for the diagnosis of Marfan syndrome include aortic root dilatation and ectopia lentis. Patients often have musculoskeletal abnormalities, other cardiovascular features, and/or other ocular manifestations. A common cutaneous manifestation of Marfan syndrome is striae distensae on the deltoid, pectoral, and/or thigh regions. Numerous textbooks and publications have stated that elastosis perforans serpiginosa is associated with Marfan syndrome. However, the bona fide coexistence of elastosis perforans serpiginosa and Marfan syndrome has only been documented in a 23-year-old woman. She not only had biopsy-confirmed elastosis perforans serpiginosa but also skeletal abnormalities (arachnodactyly, genu valgum, and kyphoscoliosis) and numerous eye findings of Marfan syndrome. An investigation using the medical search engine PubMed for "elastosis perforans serpiginosa and Marfan syndrome" does not yield any relevant citations. Therefore, to the best of my knowledge, the literature only contains the coincidental observation of elastosis perforans serpiginosa and Marfan syndrome in a single patient. In conclusion, elastosis perforans serpiginosa is not a cutaneous manifestation of Marfan syndrome.