Ultrastructural evaluation of mid‐dermal elastolysis

Abstract

Mid-dermal elastolysis is a well-defined clinical and histopathologic entity manifested by fine wrinkling of the skin and a mid-dermal loss of elastic fibers. Ultrastructural and histologic studies were performed in an attempt to better define the cause of the elastolytic process. Biopsy specimens from the lesions of 3 patients with mid-dermal elastolysis were studied at light and electron microscopic levels. Ultrastructural evidence of normal elastic fiber engulfment by activated macrophages was observed; however, some fields also demonstrated envelopment of abnormally degenerated elastic tissue. Although there are many potential causes of this degeneration, photodistribution of the lesions suggests that ultraviolet damage is a primary inciting factor.

Acquired disorders of elastic tissue: Part II. decreased elastic tissue

“…113 Exposure to ultraviolet radiation has been associated with middermal elastolysis. [114][115][116] The age group, photodistribution of lesions, history of exposure to ultraviolet radiation, and absence of actinic elastosis in most cases suggest that mid-dermal elastolysis may be the result of an idiosyncratic reaction to ultraviolet radiation rather than the cumulative effect of long-term sun exposure observed in actinic elastosis. 114 Recent investigations suggest several mechanisms of elastolysis: experiments performed with dermal fibroblasts cultured from lesional skin demonstrate an 80% reduction in elastin messenger RNA level and a 2-fold increase in elastolytic activity compared with normal skin.…”

“…Cases with an inflammatory clinical presentation have shown perivascular lymphocytic, monocytic, or neutrophilic infiltrates and phagocytosis of elastin by multinucleated giant cells. 109,110,114,[119][120][121] Electron microscopy studies have also reported phagocytosis of degenerated elastic fibers by macrophages, 109,115,116,120,122 as well as loose assembly of skeleton fibrils and irregular aggregations of dense substance. 108,109,119,122,123 In many cases, specimens stained with hematoxylin and eosin appear normal, however.…”

“…[106][107][108][109][110][111][112][113] More recently, several cases have been reported to follow urticaria, granuloma annulare, and exposure to ultraviolet radiation, suggesting that mid-dermal elastolysis may present in some cases as a postinflammatory elastolysis. 114,115 It has also been reported to follow augmentation mammaplasty with silicone gelefilled implants. 113 Exposure to ultraviolet radiation has been associated with middermal elastolysis.…”

Mid‐dermal elastolysis associated with Hashimoto's thyroiditis

“…Frequently, HT has a subclinical course without pathologic changes of thyroid hormone profile and may be easily overlooked. Laboratory screening for thyroid autoimmunity was reported only in three cases of MDE and one of these was associated with Graves' disease, which is known to be an autoimmune disorder genetically linked with HT [24,25,28,48]. Although HT is a common gynecotropic disease, and therefore may be coincidental in the present case, we recommend laboratory screening of thyroid autoimmunity in patients with MDE.…”

Mid-dermal elastolysis: A female-centric disease; case report and updated review of the literature

“…In fact, most studies do not report on treatment modalities, likely owing to the benign course of MDE. Use of topical and systemic steroids (Boyd and King, 2001, Lewis et al, 2004), colchicine (Sterling et al, 1994), and tretinoin (Harmon et al, 1994, Sterling et al, 1994) have been reported. Topical tretinoin seems to be the most widely used and has been reported to reduce wrinkles, but not to alter the natural history of the disease (Sterling et al, 1994).…”