Periumbilical perforating pseudoxanthoma elasticum (PPPXE) is a localized acquired disorder found most frequently in obese, multiparous, middle-aged women. It is characterized clinically by yellowish, lax, well-circumscribed, reticulated or cobblestoned patches or plaques in the periumbilical region. Multiparity, obesity, massive ascites, and abdominal surgery are thought to the initiating factors.