This is indeed a strange disease of the skin. Is it really a new condition, or is it an old disease which has only recently been recognized? All but one case is reported as occurring since 1950. If elastosis perforans is increasing in incidence, how can we explain such an unusual condition? Many questions arise as we study this disease, which clinically appears as arciform, nonpruritic papules, not interfering with hair growth, located mainly on the posterior aspect of the neck in young persons. The lesions are remarkably recalcitrant to almost every known form of destructive therapy. The disease has been misdiagnosed as lichen planus, granuloma annulare, Hailey and Hailey's disease, follicular lichen planus, porokeratosis, Lutz's disease, Lutz-Miescher disease, and Kyrle's disease. It is not my purpose to present a complete differential diagnosis since this has been thoroughly covered in the excellent article by Hitch and Lund.1However, it