Pseudoxanthoma Elasticum-Like Papillary Dermal Elastolysis (PXE-PDE) in an Elderly Female: A Rare Diagnostic Entity

Pseudoxanthoma elasticum-like papillary dermal elastolysis (PXE-PDE) is a rare, acquired skin disorder characterized by multiple small papules arising from degeneration of elastic fibers in the dermis. It is often underrecognized due to its benign nature and resemblance to harmless age-related skin changes and may be misdiagnosed as conditions such as pseudoxanthoma elasticum (PXE). A 70-year-old woman presented with asymptomatic skin lesions on her neck, which had gradually increased over 2-3 years. On physical examination, multiple confluent yellowish-white papules with a cobblestone appearance were observed on the neck. Skin biopsy confirmed the diagnosis of PXE-PDE, showing loss of elastic tissue in the superficial dermis. The patient underwent two sessions of CO₂ laser treatment, with approximately 40% improvement noted by both the physician and the patient. This case underscores the importance of clinicopathologic correlation in diagnosing PXE-PDE and distinguishing it from PXE and other mimickers. CO₂ laser therapy may be considered as a cosmetic treatment option in selected patients.