Papulosquamous disorders: elastosis perforans serpiginosa: practice question

A Dermatology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Dermatology · Papulosquamous disorders: elastosis perforans serpiginosa

Sample item

A young man with Down syndrome has an arciform ring of keratotic papules on the nape of the neck. Biopsy shows transepidermal elimination of altered elastic fibres through narrow channels. Which drug is a recognised cause of the same pattern?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. D-penicillamine

Elastosis perforans serpiginosa is a perforating disorder associated with Down syndrome, Ehlers-Danlos syndrome, pseudoxanthoma elasticum, osteogenesis imperfecta and long-term D-penicillamine. Elastic fibres are extruded through the epidermis. It is usually self-limited and treated with cryotherapy or topical retinoids.

Option by option

  • A. Hydroxychloroquine

    Hydroxychloroquine causes pigmentation, retinopathy and psoriasis flares, not perforation of elastic fibres.

  • B. Cetirizine

    Cetirizine is an antihistamine and is not linked to this disorder.

  • C. D-penicillamine (correct)

    Correct. D-penicillamine damages elastic tissue and can induce this perforating pattern.

  • D. Methotrexate

    Methotrexate causes mucositis, marrow and liver toxicity and is not linked to perforating elastosis.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Dermatology question

What is the answer to this Dermatology question?

The best answer is C, D-penicillamine. Elastosis perforans serpiginosa is a perforating disorder associated with Down syndrome, Ehlers-Danlos syndrome, pseudoxanthoma elasticum, osteogenesis imperfecta and long-term D-penicillamine.

Why is "Hydroxychloroquine" not the answer?

Hydroxychloroquine causes pigmentation, retinopathy and psoriasis flares, not perforation of elastic fibres.

Why is "Cetirizine" not the answer?

Cetirizine is an antihistamine and is not linked to this disorder.

Why is "Methotrexate" not the answer?

Methotrexate causes mucositis, marrow and liver toxicity and is not linked to perforating elastosis.

What concept does this question test?

It tests Papulosquamous disorders: elastosis perforans serpiginosa in Dermatology. Elastic fibres are extruded through the epidermis. It is usually self-limited and treated with cryotherapy or topical retinoids.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Papulosquamous disorders: elastosis perforans serpiginosa?

Learn each condition by its primary lesion, site and signature sign. Then use the flashcards and the other Dermatology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.