Upper-Mid Dermal Elastolysis: A case report

Abstract

Mid-dermal elastolysis (MDE) is a rare dermatologic disease affecting extracellular matrix fibers, particularly elastic fibers. It is characterized by asymptomatic, symmetrically distributed fine wrinkles with perifollicular papular protrusions. The diagnosis is confirmed by histologic elastic stains showing focal loss of elastic fibers strictly in the mid-dermal layer which helps differentiating the entity from other elastic fiber disorders.

We are hereby reporting a patient with atypically cutaneous and histological presentations of MDE. An 84 year old female presented with a history of localized wrinkles and skin-colored papules on both inframammary areas. The lesions are follicular origins and asymptomatic. The routine H&E stains revealed minimal changes but the elastic stains showed absent of elastic fibers in the upper and mid dermis sparing perifollicular areas. She lives in Bangkok, Thailand and there is no other family member experiencing the same presentation. The lesions share clinical and histologic features of both upper dermal elastolysis and mid dermal elastolysis which never been reported in previous literatures.