title: Linear Lumbar Localized Lysis of Elastic Fibers: A Distinctive Clinical Presentation of Mid-dermal Elastolysis.
abstract: BACKGROUND
  The absence or loss of elastic fibers in the skin is referred to as dermal elastolysis.
  
  
  OBJECTIVE
  This paper describes a woman with a distinctive clinical presentation of mid-dermal elastolysis characterized morphologically by multiple horizontal raised bands on the lower back.
  
  
  METHODS
  A 20-year-old Filipino woman presented with multiple asymptomatic, flesh-colored, raised, firm, linear, cord-like bands on the lumbar area of her back. There were neither similar lesions elsewhere nor a family member with this condition.
  
  
  RESULTS
  Microscopic examination of the raised band showed nearly complete absence of elastic fibers in the mid dermis. In contrast, a biopsy of symmetrically located normal-appearing skin showed a uniform distribution of elastic fibers throughout the dermis. Linear lumbar localized elastolysis is a descriptive designation that accurately reflects a correlation of the clinical and pathological changes of this condition.
  
  
  CONCLUSIONS
  The clinical differential of raised horizontal cord-like bands on the lower back (without a family history of an inherited elastic fiber disorder, a prior history of trauma, or a significant change in weight or exercise habit) includes linear focal elastosis and linear lumbar localized elastolysis. Microscopic evaluation of a Verhoeff-van Gieson stained lesion specimen (which may be accompanied by a biopsy of normal-appearing skin for comparison) will readily differentiate these conditions. The former is usually characterized by increased elastic fibers, whereas the latter, as in this patient, shows a paucity or absence of elastic fibers in the mid dermis.
authors.affiliation: The University of Houston Health Center, University of Houston, Houston, Texas; The Division of Dermatology, University of California San Diego, San Diego, California ; The Department of Dermatology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas ; The Department of Dermatology, University of Texas-Houston Medical School, Houston, Texas.
authors.forename: Philip R
authors.initials: PR
authors.lastname: Cohen
authors.forename: Jaime A
authors.initials: JA
authors.lastname: Tschen