Mid-dermal elastolysis

Author: Dr Bob Chan, Dermatology Registrar, Auckland, New Zealand, November 2014.


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 looseness of skin around hair follicles, resulting in perifollicular papules
  • Type III, presents with reticular erythema
Mid-dermal elastolysis type I

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 histopathology

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.

 

Related Information

References:

  • Gambichler T. Mid-dermal elastolysis revisited. Arch Dermatol Res 2010; 302:85-93
  • Sterling JC, Coleman N, Pye RJ. Mid-dermal elastolysis. Br J Dermatol 1994; 130:502-506
  • Bolognia JL, Jorizzo JL, Schaffer JV. Dermatology, 3rd edition 2012. Chapter 99, Atrophies of Connective Tissues. Catherine Maari and Julie Powell. Pages 1631 - 1632

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