DP13: Mid-dermal elastolysis: a study of eight cases

Niamh Byrne and Nigel Burrows

Department of Dermatology, Addenbrookes’ Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK

Mid-dermal elastolysis is a rare disorder defined by loss of elastic tissue in the mid-dermis. There are three reported morphological subtypes: type I, characterized by well-demarcated patches of fine wrinkles; type II, characterized by soft perifollicular papular protrusions; and type III, characterized by reticular erythema (Gambichler T. Mid-dermal elastolysis revisited. Arch Dermatol Res 2010; 302: 85–93; Hardin J, Dupuis E, Haber RM. Mid-dermal elastolysis: a female-centric disease; case report and updated review of the literature. Int J Womens Dermatol 2015; 1: 126–30). The condition can have a psychological and cosmetic impact. We report a series of eight novel cases. All the patients were white women. Mean age at disease onset was 37·8 years. Mean age at presentation was 42·8 years. One patient presented with perifollicular papular protrusions. The remaining patients presented with asymptomatic distinct patches of fine skin wrinkling affecting the neck, trunk and proximal limbs. The face, hands and feet were spared in all cases. Two patients had preceding granuloma annulare. Two patients described preceding asymptomatic erythema of the affected skin. One patient had a background of Raynaud syndrome. Three of the patients had a history of significant sun exposure. The diagnosis was confirmed by skin biopsy in all cases. The main histological features included a band-like focal loss of elastic fibres in the mid-reticular dermis highlighted on elastic van Gieson staining, subtle interstitial histiocytic infiltrates, mild perivascular lymphocytic infiltrates and normal epidermises. Most patients were offered treatment with topical retinoids. One patient had a trial of ciclosporin, with no clinical or histological response. The exact pathogenesis of mid-dermal elastolysis is still unknown and often goes unrecognized. The condition has been associated with inflammatory conditions such as urticaria and granuloma annulare (Gambichler et al. and Hardin et al.), which was reflected in this case series. Sun exposure has been implicated (Gambichler et al. and Hardin et al.), and three of our patients reported significant sun exposure with years lived in sunny climates and sunbed use. Sun-exposed sites such as the face and hands were spared, and histological dermal actinic damage was not evident. Although mid-dermal elastolysis is a benign condition it can cause significant cosmetic impairment and treatment options are limited. Topical retinoids may improve the clinical appearance but do not alter the course of the disease (Hardin et al.).