D-penicillamine induced elastosis perforans serpiginosa mimicking acne keloidalis nuchae

A 22-year-old man presented with itchy skin-colored papules and nodular lesions involving his front and nape of the neck and left upper limb since 4 years. He was a known case of Wilson's disease on penicillamine for the past 14 years. He developed asymptomatic raised skin lesions initially over the nape of the neck, which gradually involved the front of the neck and the flexor aspect of the left upper limb with increase in size and shape of the lesions.