title: Immunohistochemical investigation of mid-dermal elastolysis with a history of erythema.
abstract: Elastic fibers are essential extracellular matrix macromolecules comprising an elastin core surrounded by fibrillin-rich microfibrils. Fibulin-5, a microfibril, has been identified as one of the secreted extracellular matrix proteins that shows function as a scaffold for elastic fibers. However, the distribution of fibulin-5 in the skin is not clear. We report a case of a 43-year-old woman with erythema and subsequent wrinkling that met the clinical and histological criteria for mid-dermal elastolysis. We investigate the mechanism by which this disease occurs. The distribution of elastin, CD68, matrix metalloproteinase (MMP)-9, and fibulin-5 was examined immunohistochemically from both erythematous and wrinkled skin. There were numerous CD68 and MMP-9-producing histiocytes and giant cells in the erythematous lesions. Faint fibrillar staining of fibulin-5 was found in the deep dermis. In the wrinkled skin, there were few CD68 histiocytes or giant cells. Elastin immunoreactivity disappeared from the mid-dermis. Fibulin-5 colocalized in the lower dermis, shorter than in the erythema. Mid-dermal elastolysis may be initiated by MMP-9 produced by histiocytes and giant cells through its degradation of elastic fibers. In the lower dermis of the wrinkled skin, the fragmented expression of fibulin-5 was associated with the incomplete reproduction of the elastic fibers.
authors.affiliation: Department of Dermatology, Nihon University School of Medicine, Tokyo, Japan. takane@med.nihon-u.ac.jp
authors.forename: Takane
authors.initials: T
authors.lastname: Suda
authors.forename: H
authors.initials: H
authors.lastname: Hara
authors.forename: M
authors.initials: M
authors.lastname: Yoshitake
authors.forename: T
authors.initials: T
authors.lastname: Ohbayashi
authors.forename: T
authors.initials: T
authors.lastname: Nakamura
authors.forename: T
authors.initials: T
authors.lastname: Terui
mesh_terms: D000328:Adult; D015703:Antigens, CD / Q000378:metabolism; D015214:Antigens, Differentiation, Myelomonocytic / Q000378:metabolism; D020405:Dermis / Q000378:metabolism* / Q000473:pathology / Q000503:physiopathology; D004547:Elastic Tissue / Q000378:metabolism* / Q000473:pathology; D004548:Elasticity / Q000502:physiology*; D004549:Elastin / Q000378:metabolism; D004890:Erythema / Q000378:metabolism* / Q000473:pathology / Q000503:physiopathology; D016326:Extracellular Matrix Proteins / Q000378:metabolism*; D005260:Female; D006644:Histiocytes / Q000378:metabolism / Q000473:pathology; D006801:Humans; D020780:Matrix Metalloproteinase 9 / Q000378:metabolism; D000097382:CD68 Molecule
chemical_list: D015703:Antigens, CD; D015214:Antigens, Differentiation, Myelomonocytic; D004549:Elastin; D016326:Extracellular Matrix Proteins; D020780:Matrix Metalloproteinase 9; C067980:CD68 antigen, human; D000097382:CD68 Molecule; C492373:FBLN5 protein, human