Mid-dermal elastolysis preceded by acute neutrophilic dermatosis.
BACKGROUND
Mid-dermal elastolysis is a rare idiopathic elastic tissue disorder that is characterized by localized patches of finely wrinkled skin and a "band-like" loss of elastic tissue in the mid-reticular dermis. Lesions may be preceded by erythema and/or urticaria, and histological examination of inflamed lesional skin may demonstrate lymphohistiocytic dermal infiltration.


METHODS
We report a case of mid-dermal elastolysis in a 31-year-old woman who developed multiple erythematous and urticarial plaques on the arms and trunk. Histologic examination of a representative lesion revealed a neutrophilic infiltrate and a normal pattern of elastic tissue. Several months later, the erythema and urticaria was noted to have resolved, leaving soft, pendulous plaques with overlying finely wrinkled skin. A follow-up biopsy at this time showed minimal lymphocytic inflammation but almost complete absence of elastic tissue in the mid-reticular dermis.


CONCLUSIONS
To our knowledge, acute neutrophilic dermatosis resulting in mid-dermal elastolysis has not been previously described. This observation lends support to an emerging theory that the pathogenesis of mid-dermal elastolysis may be inflammatory.
Lewis
Kevan G
KG
Department of Dermatology, Brown Medical School, Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903, USA.
Dill
Sara W
SW
Wilkel
Caroline S
CS
Robinson-Bostom
Leslie
L
D000287:Administration, Topical; D000328:Adult; D002990:Clobetasol / Q000031:analogs & derivatives* / Q000627:therapeutic use; D020405:Dermis / Q000473:pathology*; D004547:Elastic Tissue / Q000473:pathology*; D005260:Female; D006801:Humans; D009824:Ointments; D011241:Prednisone / Q000627:therapeutic use; D016463:Sweet Syndrome / Q000150:complications / Q000188:drug therapy / Q000473:pathology*; D017211:Treatment Failure; D014212:Tretinoin / Q000627:therapeutic use
D009824:Ointments; D014212:Tretinoin; D002990:Clobetasol; D011241:Prednisone