Mid-dermal elastolysis

What is mid-dermal elastolysis?

Mid-dermal elastolysis is a rare, acquired skin condition of elastic tissues. Elastic fibres provide skin tissue with elastic recoil and resilience. In mid-dermal elastolysis, there is a selective loss of elastic fibres in the mid-dermis.

What are the clinical features of mid-dermal elastolysis?

Mid-dermal elastolysis has been reported mostly in Caucasian patients, with a female predominance. The most commonly affected sites are the trunk and upper arms; the face and lower legs are only occasionally affected.

There have been 3 clinical subtypes of mid-dermal elastolysis described.

• Type I, the most common subtype, presents with asymptomatic, well-demarcated areas of fine wrinkling.
• Type II presents with the looseness of skin around hair follicles, resulting in perifollicular papules.
• Type III presents with reticular erythema.

Mid-dermal elastolysis type I

Mid-dermal elastolysis 

Mid-dermal elastolysis 

Mid-dermal elastolysis 

What causes mid-dermal elastolysis?

The exact cause of mid-dermal elastolysis is unknown. It is associated with localised increased activity of elastase, an enzyme involved in elastin breakdown.

Reported associations with mid-dermal elastolysis include:

• Exposure to ultraviolet (UV) radiation
• Pregnancy
• Oral contraceptive use
• Inflammatory skin conditions
• Autoimmune diseases

What is seen on biopsy of mid-dermal elastolysis?

Biopsy features can be helpful to confirm the diagnosis of mid-dermal elastolysis. Specimens may appear normal with haematoxylin and eosin stain (H&E) or may have a discrete inflammatory infiltrate. Band-like or focal loss of elastic fibres can be seen in the mid-dermis with elastic stains.

Mid-dermal elastolysis 

Mid-dermal elastolysis 

What are the treatments for mid-dermal elastolysis?

Sun protection is recommended as UV radiation is a possible cause of mid-dermal elastolysis. Topical retinoids may improve the appearance of wrinkling.

Other treatments, including topical and systemic steroids, hydroxychloroquine, vitamin E, clofazimine, and colchicine have not been shown to be beneficial.