Perifollicular Elastolysis: A Case Report and Literature Review

Perifollicular elastolysis (PE) is a rare acquired elastolytic disorder, first described by Varadi and Saqueton in 1970, characterized by focal loss of elastic fibers around hair follicles. It is frequently underrecognized and mistaken for common conditions like acne vulgaris. This case report describes an 18-year-old female presenting with asymptomatic, skin-colored papules diffusely distributed on the chest and back persisting for over a year. Dermatological examination revealed millet-sized, noninflammatory folliculocentric papules with smooth surfaces. Histopathology demonstrated perifollicular elastic fiber fragmentation and reduction on Verhoeff-Van Gieson staining, accompanied by mild perivascular inflammation, confirming PE diagnosis. The discussion synthesizes current understanding of PE's clinical spectrum, highlighting its differentiation from mid-dermal elastolysis (MDE), papular elastorrhexis, and other elastolytic disorders through histopathological hallmarks. While the exact pathogenesis of PE remains unclear, potential triggers include mechanical trauma, bacterial elastase activity, and autoimmune dysregulation. Current management focuses on minimizing mechanical trauma and topical therapies, though no standardized treatment exists. This case underscores the need for greater awareness of PE and calls for further research to elucidate its molecular mechanisms and develop evidence-based treatments for this benign yet cosmetically concerning condition.