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Mid-dermal elastolysis revisited

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Abstract

The clinical as well as histological data of 79 mid-dermal elastolysis (MDE) patients reported in the literature were evaluated. MDE is an acquired skin condition of the elastic tissue predominantly manifesting on the trunk and proximal extremities of young women. Most commonly observed skin changes include patches of well-circumscribed fine wrinkles (type I) and perifollicular papular protrusions (type II). Rarely, MDE may also occur with persistent reticular erythema and wrinkling (type III). The critical diagnostic histopathological feature of MDE is the selective loss of elastic fibres in the mid-dermis. Mild lymphohistiocytic infiltrates, elastophagocytosis of elastic fibres by macrophages, and even multinucleate giant cells are occasionally observed in MDE lesions. Immunohistological studies and cell culture experiments indicate that dysbalances in elastin turnover are associated with pathological degradative processes including increased elastolytic activity that finally lead to loss of elastic fibres in the mid-dermis. First-line differential diagnoses may include closely related conditions such as anetoderma, annular elastolytic giant cell granuloma, cutis laxa acquisita and pseudoxanthoma elasticum-like papillary dermal elastolysis. Future therapeutic approaches in MDE patients should focus on agents that are able to block increased elastase activity and induce elastin synthesis.

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References

  1. Adams BB, Mutasim DF (2003) Colocalization of granuloma annulare and mid-dermal elastolysis. J Am Acad Dermatol 48(2 Suppl):25–27

    Article  Google Scholar 

  2. Agha AK, Hashimoto M (1994) Mid dermal elastolysis: case report and review of the literature. J Dermatol 21:760–766

    PubMed  Google Scholar 

  3. Bannister MJ, Rubel DM, Kossard S (2001) Mid-dermal elastophagocytosis presenting as a persistent reticulate erythema. Australas J Dermatol 42:50–54

    Article  PubMed  Google Scholar 

  4. Barile M, Rivara GP, Parodi A, Rebora A (1992) Postinflammatory mid-dermal elastolysis. J Eur Acad Dermatol 1:281–283

    Article  Google Scholar 

  5. Bassissi P, Leri A, Ferrari C, Alinovi A (1994) Mid-dermal elastolysis. Eur J Dermatol 4:537–539

    Google Scholar 

  6. Berton A, Rigot V, Huet E, Decarme M, Eeckhout Y, Patthy L, Godeau G, Hornebeck W, Bellon G, Emonard H (2001) Involvement of fibronectin type II repeats in the efficient inhibition of gelatinases A and B by long-chain unsaturated fatty acids. J Biol Chem 276:20458–20465

    Article  PubMed  Google Scholar 

  7. Boyd AS, King LE Jr (2001) Middermal elastolysis in two patients with lupus erythematosus. Am J Dermatopathol 23:136–138

    Article  PubMed  Google Scholar 

  8. Braun-Falco M, Krahl D, Petzoldt D (1995) Elastosis mediodermalis—Kasuistik und Übersicht. Z Hautkr 70:249–256

    Google Scholar 

  9. Brennan M, Bhatti H, Nerusu KC, Bhagavathula N, Kang S, Fisher GJ, Varani J, Voorhees JJ (2003) Matrix metalloproteinase-1 is the major collagenolytic enzyme responsible for collagen damage in UV-irradiated human skin. Photochem Photobiol 78:43–48

    Article  PubMed  Google Scholar 

  10. Brenner W, Gschnait F, Konrad K, Holubar K, Tappeiner J (1978) Non-inflammatory dermal elastolysis. Br J Dermatol 99:335–338

    Article  PubMed  Google Scholar 

  11. Brod BA, Rabki M, Rhodes AR, Jegasothy BV (1992) Mid-dermal elastolysis with inflammation. J Am Acad Dermatol 26:882–884

    Article  PubMed  Google Scholar 

  12. Cho S, Lee MJ, Kim MS, Lee S, Kim YK, Lee DH, Lee CW, Cho KH, Chung JH (2008) Infrared plus visible light and heat from natural sunlight participate in the expression of MMPs and type I procollagen as well as infiltration of inflammatory cell in human skin in vivo. J Dermatol Sci 50:123–133

    Article  PubMed  Google Scholar 

  13. Cozzani E, Santoro F, Parodi A (2009) Mid-dermal elastolysis with prothrombotic abnormalities: two cases. Br J Dermatol 161:203–205

    Article  PubMed  Google Scholar 

  14. Crivellato E (1986) Disseminated nevus anelasticus. Int J Dermatol 25:171–173

    Article  PubMed  Google Scholar 

  15. Eaton PA, Knable AL, Callen JP (2009) Mid-dermal elastolysis in a patient undergoing chronic hemodialysis. Cutis 83:141–144

    PubMed  Google Scholar 

  16. Fimiani M, Mazzatenta C, Alessandrini C, Paola M, Paola C, Andreassi L (1995) Mid-dermal elastolysis: an ultrastructural and biochemical study. Arch Dermatol Res 287:152–157

    Article  PubMed  Google Scholar 

  17. Fornieri C, Quaglino D, Lungarella G, Cavarra E, Tiozzo R, Giro MG, Canciani M, Davidson JM, Ronchetti IP (1994) Elastin production and degradation in cutis laxa acquisita. J Invest Dermatol 103:583–588

    Article  PubMed  Google Scholar 

  18. Gambichler T, Linhart C, Wolter M, Berger C, Berger D (1999) Mediodermale Elastolyse—Quantitative Auswertung von 44 Fällen aus der Literatur. Akt Dermatol 25:55–59

    Google Scholar 

  19. Gambichler T, Linhart C, Wolter M (1999) Mid-dermal elastolysis associated with Hashimoto’s thyroiditis. J Eur Acad Dermatol Venereol 12:245–249

    Article  PubMed  Google Scholar 

  20. Gambichler T, Boms S, Kreuter A, Altmeyer P, Stücker M (2004) Umschriebene feine Fältelung entlang der Hautspannungslinien. Hautarzt 55:318–321

    Article  PubMed  Google Scholar 

  21. Gambichler T, Breuckmann F, Kreuter A, Boms S, Altmeyer P, Stücker M (2004) Immunohistochemical investigation of mid-dermal elastolysis. Clin Exp Dermatol 29:192–195

    Article  PubMed  Google Scholar 

  22. Gheduzzi D, Boraldi F, Annovi G, DeVincenzi CP, Schurgers LJ, Vermeer C, Quaglino D, Ronchetti IP (2007) Matrix Gla protein is involved in elastic fiber calcification in the dermis of pseudoxanthoma elasticum patients. Lab Invest 87:998–1008

    Article  PubMed  Google Scholar 

  23. Ghomrasseni S, Dridi M, Gogly B, Bonnefoix M, Vabres P, Venencie PY, Pellat B, Godeau G (2002) Anetoderma: an altered balance between metalloproteinases and tissue inhibitors of metalloproteinases. Am J Dermatopathol 24:118–129

    Article  PubMed  Google Scholar 

  24. Harmon CB, Su WPD, Gagne EJ, Fransway AF, Zelickson BD (1994) Ultrastructural evaluation of mid-dermal elastolysis. J Cutan Pathol 21:233–238

    Article  PubMed  Google Scholar 

  25. Hashimoto K, Tye MJ (1994) Upper dermal elastolysis: a comparative study with mid-dermal elastolysis. J Cutan Pathol 21:533–540

    PubMed  Google Scholar 

  26. Heudes AM, Boullie MC, Thomine E, Lauret P (1988) Élastolyse aquise en nappe du derme moyen. Ann Dermatol Venereol 115:1041–1045

    PubMed  Google Scholar 

  27. Hillen U (2008) Reticular erythema with focal mid-dermal elastophagocytosis (REMDE). J Dtsch Dermatol Ges 6:857–859

    PubMed  Google Scholar 

  28. Hodak E, David M (2007) Primary anetoderma and antiphospholipid antibodies—review of the literature. Clin Rev Allergy Immunol 32:162–166

    Article  PubMed  Google Scholar 

  29. Hohenleutner S, Wlotzke U, Landthaler M, Stolz W (1997) Elastolyse der mittleren Dermis und annuläres elastolytisches Riesenzellgranulom: Unterschiedliche Stadien im klinischen Spektrum der dermalen Elastolyse? Hautarzt 48:45–50

    Article  PubMed  Google Scholar 

  30. Hürlimann AF, Trüeb RM, Panizzon RG (1995) Idiopathische Elastolyse der mittleren Dermis. Hautarzt 46:425–428

    Article  PubMed  Google Scholar 

  31. Hur DJ, Raymond GV, Kahler SG, Riegert-Johnson DL, Cohen BA, Boyadjiev SA (2005) A novel MGP mutation in a consanguineous family: review of the clinical and molecular characteristics of Keutel syndrome. Am J Med Genet A 135:36–40

    PubMed  Google Scholar 

  32. Ishida Y, Koizumi N, Shinkai H, Miyachi Y, Utani A (2005) Primary anetoderma: a case report and its modified classification. J Dermatol 32:982–986

    PubMed  Google Scholar 

  33. Isnard N, Péterszegi G, Robert AM, Robert L (2002) Regulation of elastase-type endopeptidase activity, MMP-2 and MMP-9 expression and activation in human dermal fibroblasts by fucose and a fucose-rich polysaccharide. Biomed Pharmacother 56:258–264

    Article  PubMed  Google Scholar 

  34. Kielty CM (2006) Elastic fibres in health and disease. Expert Rev Mol Med 8:1–23

    Article  PubMed  Google Scholar 

  35. Kim JM, Su WPD (1992) Mid dermal elastolysis with wrinkling. J Am Acad Dermatol 26:169–173

    Article  PubMed  Google Scholar 

  36. Kirsner RS, Falanga V (1992) Features of an autoimmune process in mid-dermal elastolysis. J Am Acad Dermatol 27:832–834

    Article  PubMed  Google Scholar 

  37. Koursh DM, Modjtahedi SP, Selva D, Leibovitch I (2009) The blepharochalasis syndrome. Surv Ophthalmol 54:235–244

    Article  PubMed  Google Scholar 

  38. LeBoit PE (1994) Granulomatous slack skin. Dermatol Clin 12:375–389

    PubMed  Google Scholar 

  39. Lemarchand-Venencie F, Venencie PY, Foix C, Sanson MJ, Chérif F, Civatte J (1985) Perifollicular elastolysis. Discussion of the role of secretory elastase from Staphylococcus epidermidis. Ann Dermatol Venereol 112:735–736

    PubMed  Google Scholar 

  40. Limas C (2004) The spectrum of primary cutaneous elastolytic granulomas and their distinction from granuloma annulare: a clinicopathological analysis. Histopathology 44:277–282

    Article  PubMed  Google Scholar 

  41. Lewis KG, Dill SW, Wilkel CS, Robinson-Bostom L (2004) Mid-dermal elastolysis preceded by acute neutrophilic dermatosis. J Cutan Pathol 31:72–76

    Article  PubMed  Google Scholar 

  42. Lewis KG, Bercovitch L, Dill SW, Robinson-Bostom L (2004) Acquired disorders of elastic tissue. Part II. Decreased elastic tissue. J Am Acad Dermatol 51:165–185

    Article  PubMed  Google Scholar 

  43. Maghraoui S, Grossin M, Crickx B, Blanchet P, Belaich S (1992) Mid dermal elastolysis. J Am Acad Dermatol 26:490–492

    Article  PubMed  Google Scholar 

  44. Maghraoui S, Grossin M, Crickx B, Blanchet P, Belaich S (1994) L’Élasolyse acquise du derme moyen. Deux nouvelles observations. Ann Dermatol Venereol 121:245–246

    PubMed  Google Scholar 

  45. Marshall J, Heyl T, Weber HW (1966) Postinflammatory elastolysis and cutis laxa. A report on a new variety of this phenomenon and a discussion of some syndromes characterized by elastolysis. S Afr Med J 40:1016–1022

    PubMed  Google Scholar 

  46. Martin LK, Kossard S, Murrell DF (2008) Reticular variant of mid-dermal elastolysis. Am J Dermatopathol 30:287–290

    Article  PubMed  Google Scholar 

  47. Morava E, Guillard M, Lefeber DJ, Wevers RA (2009) Autosomal recessive cutis laxa syndrome revisited. Eur J Hum Genet 17:1099–1110

    Article  PubMed  Google Scholar 

  48. Moulonguet-Michau I, Kapetis E, Lefaki I, Marinho E, Blanchet-Bardon C, Civatte J (1990) L’Élasolyse acquise du derme moyen. Ann Dermatol Venereol 117:911–913

    PubMed  Google Scholar 

  49. Müller FB, Groth W (2007) Annular elastolytic giant cell granuloma: a prodromal stage of mid-dermal elastolysis? Br J Dermatol 156:1377–1379

    Article  PubMed  Google Scholar 

  50. Nashan D, Sunderkötter C, Rütter A, Luger T, Metze D (1995) Mid-dermale Eastolyse—Fallbeschreibung und Gegenüberstellung der Erkrankungen des des elastolytischen Formenkreises. Z Hautkr 70:655–658

    Google Scholar 

  51. Neri I, Patrizi A, Fanti PA, Passarini B, Badiali-De Giorgi L, Varotti C (1996) Mid-dermal elastolysis: a pathological and ultrastructural study of five cases. J Cutan Pathol 23:165–169

    Article  PubMed  Google Scholar 

  52. Ortel B, Rappersberger K, Konrad K (1992) Middermal elastolysis in an elderly man with evidence of elastic fiber phagocytosis. Arch Dermatol 128:88–90

    Article  PubMed  Google Scholar 

  53. Pajot C, Le Clec’h C, Hoareau F, Croue A, Verret JL (2008) Two cases of papular elastorrhexis. Ann Dermatol Venereol 135:757–761

    Article  PubMed  Google Scholar 

  54. Patroi I, Annessi G, Girolomoni G (2003) Mid-dermal elastolysis: a clinical, histologic, and immunohistochemical study of 11 patients. J Am Acad Dermatol 48:846–851

    Article  PubMed  Google Scholar 

  55. Prigent F, Baulac C, Durosselle M, Mrinho E, Bernager JY, Frances C, Martinet C (1993) Elastolyse du derme moyen: une observation étude des élastases. Ann Dermatol Venereol 120:853–855

    PubMed  Google Scholar 

  56. Rae V, Falanga V (1989) Wrinkling due to middermal elastolysis. Report of a case and review of the literature. Arch Dermatol 125:950–951

    Article  PubMed  Google Scholar 

  57. Rao BK, Endzweig CH, Kagen MH, Kriegel D, Freeman RG (2000) Wrinkling due to mid-dermal elastolysis: two cases and literature review. J Cutan Med Surg 4:40–44

    PubMed  Google Scholar 

  58. Rock MJ, Cain SA, Freeman LJ, Morgan A, Mellody K, Marson A, Shuttleworth CA, Weiss AS, Kielty CM (2004) Molecular basis of elastic fiber formation. Critical interactions and a tropoelastin-fibrillin-1 cross-link. J Biol Chem 279:23748–23758

    Article  PubMed  Google Scholar 

  59. Rothfleisch JE (2001) Mid-dermal elastolysis. Dermatol Online J 7:15

    PubMed  Google Scholar 

  60. Rudolph R (1990) Mid dermal elastolysis. J Am Acad Dermatol 22:203–206

    Article  PubMed  Google Scholar 

  61. Sans B, Dupin P, Bouisson X, Bazex J (1989) Élastolyse acquise. Ann Dermatol Venereol 116:325

    PubMed  Google Scholar 

  62. Schlötzer-Schrehardt U, Stojkovic M, Hofmann-Rummelt C, Cursiefen C, Kruse FE, Holbach LM (2005) The Pathogenesis of floppy eyelid syndrome: involvement of matrix metalloproteinases in elastic fiber degradation. Ophthalmology 112:694–704

    Article  PubMed  Google Scholar 

  63. Shelley WB, Wood MG (1977) Wrinkles due to idiopathic loss of mid-dermal elastic tissue. Br J Dermatol 97:441–445

    Article  PubMed  Google Scholar 

  64. Snider RL, Lang PG, Miaze JC (1993) The clinical spectrum of mid-dermal elastolysis and the role of UV light in its pathogenesis. J Am Acad Dermatol 28:38–42

    Google Scholar 

  65. Sterling JC, Coleman N, Pye RJ (1994) Mid-dermal elastolysis. Br J Dermatol 130:502–506

    Article  PubMed  Google Scholar 

  66. Streams BN, Williams JM, Moschella SM (2003) Mid-dermal elastolysis. Cutis 71:312–314

    PubMed  Google Scholar 

  67. Suda T, Hara H, Yoshitake M, Ohbayashi T, Nakamura T, Terui T (2008) Immunohistochemical investigation of mid-dermal elastolysis with a history of erythema. Am J Dermatopathol 30:477–480

    Article  PubMed  Google Scholar 

  68. Tajima S, Inazumi T, Kajiya H, Osakabe T, Seyama Y, Sakamoto H, Nagamatsu Y, Izaki S (1999) Elastin metabolism in skin fibroblasts explanted from a patient with mid-dermal elastolysis. Br J Dermatol 140:752–754

    PubMed  Google Scholar 

  69. Thörneby K, Sakai L, Dahlbäck K (1991) Middermal elastolysis. Report of a case and immunohistochemical studies on the dermal distribution of fibrillin, vitronectin and amyloid P component. Acta Derm Venereol (Stockh) 71:1–5

    Google Scholar 

  70. Trüeb RM, Burg G (1993) Idiopathic middermal elastolysis. Dermatology 187:62–66

    Article  PubMed  Google Scholar 

  71. Tock CL, Cohen PR (1998) Annular elastolytic giant cell granuloma. Cutis 62:181–187

    PubMed  Google Scholar 

  72. Tsuji T, Hamada T (1981) Age-related changes in human dermal elastic fibres. Br J Dermatol 105:57–63

    Article  PubMed  Google Scholar 

  73. Vaalamo M, Kariniemi AL, Shapiro SD, Saarialho-Kere U (1999) Enhanced expression of human metalloelastase (MMP-12) in cutaneous granulomas and macrophage migration. J Invest Dermatol 112:499–505

    Article  PubMed  Google Scholar 

  74. Vargas-Díez E, Peñas PF, Fraga J, Aragües M, García-Díez A (1997) Pseudoxanthoma elasticum-like papillary dermal elastolysis. A report of two cases and review of the literature. Acta Derm Venereol 77:43–45

    PubMed  Google Scholar 

  75. Vatve M, Morton R, Bilsland D (2009) A case of mid-dermal elastolysis after narrowband ultraviolet B phototherapy. Clin Exp Dermatol 34:263–264

    Article  PubMed  Google Scholar 

  76. Venencie PY, Winkelmann RK (1984) Histopathologic findings in anetoderma. Arch Dermatol 120:1040–1044

    Article  PubMed  Google Scholar 

  77. Venencie PY, Bonnefoy A, Gogly B, Groult N, Kut C, Pellat B, Hornebeck W, Godeau G (1997) Increased expression of gelatinases A and B by skin explants from patients with anetoderma. Br J Dermatol 137:517–525

    Article  PubMed  Google Scholar 

  78. Volz A, Pfister-Wartha A, Bruckner-Tuderman L, Braun-Falco M (2009) Perifollicular protrusions—mid-dermal elastolysis. J Dtsch Dermatol Ges 7:68–69

    PubMed  Google Scholar 

  79. Wang AR, Lewis K, Lewis M, Robinson-Bostom L (2008) Papillary dermal elastosis: a unique elastic tissue disorder or an unusual manifestation of pseudoxanthoma elasticum-like papillary dermal elastolysis? J Cutan Pathol 36:1010–1013

    Article  PubMed  Google Scholar 

  80. Wiederholt T, Megahed M (2007) Mid-dermal elastolysis. Hautarzt 58:386–388

    Article  PubMed  Google Scholar 

  81. Yen A, Tschen J, Raimer SS (1997) Mid-dermal elastolysis in an adolescent subsequent to lesions resembling granuloma annulare. J Am Acad Dermatol 37:870–872

    Article  PubMed  Google Scholar 

  82. Zaki I, Scerri L, Nelson H (1994) Primary anetoderma: phagocytosis of elastic fibres by macrophages. Clin Exp Dermatol 19:388–390

    Article  PubMed  Google Scholar 

  83. Zhao R, Bruning E, Rossetti D, Starcher B, Seiberg M, Iotsova-Stone V (2009) Extracts from Glycine max (soybean) induce elastin synthesis and inhibit elastase activity. Exp Dermatol 18:883–886

    Article  PubMed  Google Scholar 

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  1. Department of Dermatology, Ruhr-University Bochum, Gudrunstr. 56, 44791, Bochum, Germany

    Thilo Gambichler

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Gambichler, T. Mid-dermal elastolysis revisited. Arch Dermatol Res 302, 85–93 (2010). https://doi.org/10.1007/s00403-009-1004-0

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