Late-onset focal dermal elastosis is a condition characterized by a localized increase in healthy-appearing elastic tissue in the mid and deep reticular dermis The condition may clinically mimic pseudoxanthoma elasticum (PXE) and linear focal elastosis We report a case of an 87-year-old woman who presented with a markedly thickened, yellow, pruritic plaque on the posterior neck and discuss the clinical and histopathologic distinctions between late-onset focal dermal elastosis, PXE, and linear focal elastosis Cutis 2010,85 195-197