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Laghi A, Mandel VD, Zubba I, Franceschini C, Demofonte I, Chello C, Miraglia E, Ardigò M, Giustini S. Comprehensive analysis of pseudoxanthoma elasticum: epidemiological, genetic, and clinical findings from the leading Italian center. Ital J Dermatol Venerol 2024; 159:430-435. [PMID: 39069841 DOI: 10.23736/s2784-8671.24.07949-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
BACKGROUND Pseudoxanthoma elasticum (PXE) is a rare genetic autosomal recessive metabolic disease characterized by progressive mineralization and fragmentation of elastic fibers from soft connective tissues. The objective of our study was to analyze the epidemiological, genetic, cutaneous, and extracutaneous clinical data from the largest Italian monocentric cohort of PXE patients. METHODS We included all patients diagnosed with PXE and referred to Neurocutaneous Rare Diseases at Umberto I Polyclinic Hospital (Rome, Italy) between January 1983 and February 2024. A retrospective analysis of their data was performed. RESULTS We enrolled 86 patients (77.9% women), revealing compound heterozygosity in 19.8% of cases and homozygosity in 5.8%. Missense (34.9%), non-sense (5.8%), splice-site (5.8%), deletion (4.7%), and frameshift (2.3%) mutations were disclosed. Cutaneous alterations were noted in the neck (69.7%), axilla (33.7%), inguinal (17.5%), and cubital folds (11.7%). The most common ocular findings were angioid streaks (64.0%) and choroidal neovascularization (18.6%), with blindness reported in 5.8% of cases. Thicker intima-media was observed around the mid-fifties in the supra-aortic trunks (40.7%), lower limb arteries (32.6%), and renal arteries (4.7%). Regurgitation was more common in atrioventricular valves (48.8%) than in semilunar ones (10.5% and 9.3%). Dyslipidemia (19.8%), hypertension (18.8%), and fatty liver disease (12.8%) were prevalent, with calcifications found in the kidneys (25.6%), liver (15.1%), spleen (11.6%), and testicles (8.1% of males). Autoimmune diseases and depression were observed in 11.6% and 4.7% of cases, respectively. CONCLUSIONS Enhanced understanding of PXE can improve patients' quality of life and facilitate the development of more effective therapeutic strategies.
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Affiliation(s)
- Alessandro Laghi
- Unit of Dermatology and STDs, Department of Medicine, Celio Military Hospital, Rome, Italy -
- Unit of Dermatology, Department of Internal Medicine and Medical Specialties, Sapienza University, Rome, Italy -
| | - Victor D Mandel
- Unit of Porphyria and Rare Diseases, IRCCS San Gallicano Dermatological Institute, Rome, Italy
| | - Ilaria Zubba
- Unit of Dermatology, Department of Internal Medicine and Medical Specialties, Sapienza University, Rome, Italy
| | - Chiara Franceschini
- Unit of Porphyria and Rare Diseases, IRCCS San Gallicano Dermatological Institute, Rome, Italy
| | - Ilaria Demofonte
- Unit of Dermatology, Department of Internal Medicine and Medical Specialties, Sapienza University, Rome, Italy
| | - Camilla Chello
- Unit of Dermatology, Department of Internal Medicine and Medical Specialties, Sapienza University, Rome, Italy
| | - Emanuele Miraglia
- Department of Dermatology, San Sebastiano Hospital, Frascati, Rome, Italy
| | - Marco Ardigò
- Unit of Porphyria and Rare Diseases, IRCCS San Gallicano Dermatological Institute, Rome, Italy
- Unit of Dermatology, IRCCS Humanitas Clinic, Rozzano, Milan, Italy
| | - Sandra Giustini
- Unit of Dermatology, Department of Internal Medicine and Medical Specialties, Sapienza University, Rome, Italy
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Aryal S, Li Y, Bashyal S, Qiang LY, Rehman A. A Case Report on Mid-Dermal Elastolysis: A Distinctive Presentation on the Neck. Cureus 2023; 15:e45724. [PMID: 37868427 PMCID: PMC10590218 DOI: 10.7759/cureus.45724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 10/24/2023] Open
Abstract
Mid-dermal elastolysis (MDE) is a very rare and acquired skin condition. MDE has a variety of clinical manifestations that can be presented with a reticular erythematous patch with telangiectasis, perifollicular popular protrusions, or finely wrinkled skin. A biopsy is always necessary to rule out other potential elastic fiber disorders. In this case study, a 33-year-old female with an odd MDE presentation in her neck area is examined. No contributing factors, apart from exposure to sunlight, could be gleaned from the patient's history. The patient didn't benefit from the application of various types of topical agents or any other therapies to lessen the size and advancement of the lesion. In this distinct case, we discuss clinical and histological findings and the treatment plan offered, as well as include a concise review of specific past literature.
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Affiliation(s)
- Sabita Aryal
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University, Shanghai, CHN
| | - Yaoyu Li
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University, Shanghai, CHN
| | - Subodh Bashyal
- Department of Endocrinology and Metabolism, Tenth People's Hospital, Tongji University, Shanghai, CHN
| | - Liu Ye Qiang
- Department of Dermatology, Shanghai Skin Disease Hospital, Tongji University, Shanghai, CHN
| | - Abdur Rehman
- Department of Surgery, Mayo Hospital, Lahore, PAK
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3
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Sinha P, Vashisht D, Madakshira MG, Sharma J. A Case of Mid-Dermal Elastolysis in a Male Patient with Dermoscopic Features. Indian Dermatol Online J 2023; 14:540-542. [PMID: 37521229 PMCID: PMC10373819 DOI: 10.4103/idoj.idoj_392_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/30/2022] [Accepted: 09/19/2022] [Indexed: 08/01/2023] Open
Affiliation(s)
- Preema Sinha
- Department of Dermatology, Base Hospital, Lucknow, Uttar Pradesh, India
| | - Deepak Vashisht
- Department of Dermatology, Base Hospital, Lucknow, Uttar Pradesh, India
| | | | - Juhi Sharma
- Department of Dermatology, Base Hospital, Lucknow, Uttar Pradesh, India
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4
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Maranini B, Ciancio G, Rinaldi R, Borrelli M, Pugliatti M, Govoni M. SAPHO Syndrome Presenting With Atlo-Epistrophic Synovitis and Left Vocal Cord Paresis: A Challenging Diagnosis. CLINICAL MEDICINE INSIGHTS: ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2022; 15:11795441221118918. [PMID: 36090594 PMCID: PMC9459495 DOI: 10.1177/11795441221118918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 07/21/2022] [Indexed: 11/16/2022]
Abstract
SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) is a rare
syndrome mainly characterized by cutaneous and osteoarticular
manifestations. The most typical osteoarticular manifestations are
localized to the anterior chest wall and include a usually
noninfectious osteitis, hyperostosis, and synovitis of the
sternoclavicular joints. However, clinical presentation of SAPHO
syndrome can be quite heterogeneous. Several clinical and radiological
features are shared with other well-defined pathological entities, and
clinical signs and symptoms often occur at different timepoints.
Mainly due to this complexity and its rarity, there are currently no
validated diagnostic criteria for SAPHO syndrome. Inflammation of the
soft tissues around the bones and possible nerve compression could
contribute to dysphagia, hypophonia, or obstruction of the airways.
Neurologic manifestations could therefore be part of this multiorgan
involvement. Here, we present a case of SAPHO syndrome with atypical
onset symptoms, characterized by left vocal cord paralysis, acute neck
pain due to osteolytic atlantoepistrophic lesion, and an unusual
cutaneous manifestation, diagnosed as mid-dermal elastolysis. The
latest two, to the best of our knowledge, have been here first
described in a case of SAPHO syndrome.
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Affiliation(s)
- Beatrice Maranini
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Giovanni Ciancio
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Rosa Rinaldi
- Pathology Unit, ASST Mantova, Ospedale Carlo Poma, Mantova, Italy
| | - Massimo Borrelli
- Neurororadiology Unit, Department of Radiology, Azienda Ospedaliero-Universitaria Sant’Anna, Ferrara, Italy
| | - Maura Pugliatti
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Marcello Govoni
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
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5
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Henebeng E, Karasko E, Robinson-Bostom L, DiMarco C. Secondary Syphilis With Elastophagocytosis: An Unusual Histologic Finding. Am J Dermatopathol 2021; 43:225-227. [PMID: 33298710 DOI: 10.1097/dad.0000000000001832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Elastophagocytosis is a characteristic finding of granulomatous and elastolytic disorders. It is defined by phagocytosed elastic fibers within histiocytes, multinucleated giant cells, or both. This finding has also been associated with certain medications, malignancies, inflammatory conditions, and infectious disorders. Although Drs Ragaz and Ackerman reported elastophagocytosis in a secondary syphilis lesion in a review of actinic granuloma in 1979, more recent publications have not recognized this finding. We present a case of elastophagocytosis within a lesion of secondary syphilis in a 65-year-old man. Biopsy from his left forearm demonstrated features of secondary syphilis including subtle vacuolar alteration with mild superficial and mid perivascular lymphoplasmacytic inflammation. There were interstitial giant cells with phagocytosed elastic fibers within the superficial dermis. Spirochete immunostain was positive with confirmatory Treponema pallidum IgG antibody and RPR titer. In this report, we present a unique case of secondary syphilis.
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Affiliation(s)
- Esther Henebeng
- Department of Dermatology, The Warren Alpert Medical School, Brown University, Providence, RI; and
| | - Erich Karasko
- Department of Dermatology, Brown Dermatology, Providence, RI
| | - Leslie Robinson-Bostom
- Department of Dermatology, The Warren Alpert Medical School, Brown University, Providence, RI; and
- Department of Dermatology, Brown Dermatology, Providence, RI
| | - Christopher DiMarco
- Department of Dermatology, The Warren Alpert Medical School, Brown University, Providence, RI; and
- Department of Dermatology, Brown Dermatology, Providence, RI
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6
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van Delft LCJ, Abdul Hamid M, van Leersum FS. Middermal Elastolysis-A Possible End Stage of Granuloma Annulare. JAMA Dermatol 2021; 156:1024-1026. [PMID: 32401268 DOI: 10.1001/jamadermatol.2020.0552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Lieke C J van Delft
- Department of Dermatology, Maastricht University Medical Center, Maastricht, the Netherlands.,GROW Research Institute for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - Myrurgia Abdul Hamid
- Department of Pathology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Frank S van Leersum
- Department of Dermatology, Maastricht University Medical Center, Maastricht, the Netherlands.,GROW Research Institute for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
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7
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Atzori L, Ferreli C, Pilloni L, Rongioletti F. Pseudoxanthoma elasticum-like papillary dermal elastolysis: A mimicker of genetic pseudoxanthoma elasticum. Clin Dermatol 2020; 39:206-210. [PMID: 34272011 DOI: 10.1016/j.clindermatol.2020.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Pseudoxanthoma elasticum (PXE)-like papillary dermal elastolysis (PDE) is an acquired, rare, elastic tissue disorder that presents with multiple asymptomatic, nonfollicular yellowish or normochromic papules, coalescing into symmetrical cobblestone plaques, with a predilection for the neck of postmenopausal women. The condition develops slowly, in months to years, and, although clinically similar to PXE, it is devoid of any systemic implication, being only of esthetic concern. The etiology is unknown, but it is speculated that there is a multifactorial pathogenesis, with the contribution of intrinsic aging, exposure to ultraviolet radiation, abnormal elastogenesis, and genetic factors. The diagnosis is confirmed by histopathology, with special stains specific for elastic fibers revealing loss of elastic plexus in the papillary dermis and the presence of melanophages. Its prevalence is probably underestimated, which reinforces the importance of better clinical and histologic identification to distinguish it from inherited PXE and to avoid extensive systemic investigations and unnecessary medical visits for the patient.
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Affiliation(s)
- Laura Atzori
- Dermatology Clinic, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
| | - Caterina Ferreli
- Dermatology Clinic, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Luca Pilloni
- Pathology Unit, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Franco Rongioletti
- Dermatology Clinic, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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8
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Nabatanzi A, Da S, Male M, Chen S, Huang C. Type II acquired cutis laxa associated with recurrent urticarial vasculitis: brief report. Allergy Asthma Clin Immunol 2020; 16:1. [PMID: 31911804 PMCID: PMC6942328 DOI: 10.1186/s13223-019-0401-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 12/25/2019] [Indexed: 11/10/2022] Open
Abstract
Background Cutis laxa is a connective tissue disease characterized by loose, wrinkled, and redundant skin. It is either inherited or acquired. In most cases, acquired cutis laxa is associated with neoplasms, drugs, and autoimmune diseases. We present a rare case of acquired cutis laxa following a recurrent urticaria-like eruption in the absence of an autoimmune disease, neoplasm, drugs and or syndrome. Case presentation We report a case of a 45-year-old Chinese lady with a 1-year history of widespread pruritic urticarial eruption and a 6-month history of progressive skin wrinkling. On examination, the patient appeared older than her actual age, with apparent wrinkling on the mid-torso with generalized smooth, erythematous macules and wheals. A family history of similar conditions was absent. Biopsy revealed hypersensitivity and atrophy. Following the Food and Drug Administration (FDA) guidelines, we administered antihistamines, which relieved the itching, but her hyperpigmentation and cutis laxa never improved. Conclusion Our case shows that the decrease of elastic fibers may be associated with the infiltration of inflammatory cells in the dermis. This supports the hypothesis that chemical mediators may play a major role in the destruction of elastic fibers, thus causing cutis laxa. In addition, we advise practitioners to take a complete clinical and family history to determine if the condition is inherited or acquired.
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Affiliation(s)
- Amelia Nabatanzi
- 1Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 China
| | - Siqi Da
- 1Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 China
| | - Musa Male
- 2Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Siyuan Chen
- 1Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 China
| | - Changzheng Huang
- 1Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 China
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9
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Tronnier M. Cutaneous disorders characterized by elastolysis or loss of elastic tissue. J Dtsch Dermatol Ges 2019; 16:183-191. [PMID: 29418081 DOI: 10.1111/ddg.13430] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 12/03/2017] [Indexed: 01/06/2023]
Abstract
Along with collagen, elastic fibers are integral components of cutaneous connective tissue. A decrease in elastic fibers or loss thereof has been described in a number of clinically distinct skin diseases, both hereditary and acquired. In disorders associated with inflammation, elastophagocytosis is an important histological hallmark. Treatment is generally difficult.
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Affiliation(s)
- Michael Tronnier
- Department of Dermatology, Venereology, and Allergology, HELIOS Medical Center Hildesheim, Hildesheim, Germany
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10
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Smithson SL, Orchard D, Scardamaglia L. Mycophenolate mofetil to treat mid-dermal elastolysis. Pediatr Dermatol 2018; 35:e221-e223. [PMID: 29683223 DOI: 10.1111/pde.13511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Mid-dermal elastolysis is an acquired skin condition affecting the elastin fibers of the dermis, resulting in laxity of the skin. We report a case of mid-dermal elastolysis for which novel treatment with mycophenolate mofetil was successful.
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Affiliation(s)
- Sarah L Smithson
- Department of Dermatology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - David Orchard
- Department of Dermatology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Laura Scardamaglia
- Department of Dermatology, Royal Children's Hospital, Melbourne, Victoria, Australia
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11
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Gambichler T, Mahjurian-Namari M, Reininghaus L, Schmitz L, Skrygan M, Schulze HJ, Schaller J, Girolomoni G. Lysyl oxidase-like-2 mutations and reduced mRNA and protein expression in mid-dermal elastolysis. Clin Exp Dermatol 2018; 44:47-51. [PMID: 29845638 DOI: 10.1111/ced.13652] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2017] [Indexed: 01/26/2023]
Abstract
BACKGROUND Mid-dermal elastolysis (MDE) is a rare skin condition, characterized by selective loss of elastic fibres in the mid dermis. The pathogenesis of MDE is still unclear. AIM To investigate expression of lysyl oxidase-like 2 (LOXL2) in a reasonable sample of patients with MDE and to search for mutations in LOXL2. METHODS We investigated archived lesional tissue of 13 patients with MDE and skin tissue samples of 10 sex- and age-matched healthy controls (HCs). Gene and protein expression of LOXL2 was investigated using real-time reverse-transcription PCR and immunohistochemistry. Mutation analysis was performed using the Sanger method. RESULTS We observed decreased LOXL2 mRNA expression in lesional skin of patients with MDE (0.48 ± 0.16) compared with healthy skin of the same patients (1.5 ± 0.51) and normal skin of HCs (1.9 ± 0.13). Compared with healthy patient skin (epidermis 2.38 ± 1.6, dermis 1.2 ± 1), LOXL2 protein expression in lesional patient skin (epidermis 1.1 ± 0.7, dermis 0.3 ± 0.45) was significantly decreased (P < 0.04 and P = 0.02, respectively). Mutation analysis of the entire LOXL2 gene could be performed for five patients, all of whom were found to have at least one mutation in the LOXL2 gene. Three of these had a mutation in the promoter region (c.967 G>C, c.1022 C>T, and c.1025 G>A, respectively), and one of them also had a mutation in the splice region of intron 11/exon 12 (IVS11-1 G>A). Of the remaining two patients, one had a mutation in exon 3 (T1391), and the other had a mutation in exon 11 (C663Y). CONCLUSIONS Our present data suggest that decreased elastin renewal due to LOXL2 mutations and consecutive reduced LOXL2 expression contribute to the pathogenesis of MDE.
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Affiliation(s)
- T Gambichler
- Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | | | - L Reininghaus
- Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - L Schmitz
- Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - M Skrygan
- Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - H-J Schulze
- Fachklinik Hornheide, Department of Dermatology and Dermato-Histo-Pathology, Münster, Germany
| | - J Schaller
- Dermatopathology Duisburg, Duisburg, Germany
| | - G Girolomoni
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
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12
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Tronnier M. Elastolysen und Hauterkrankungen mit Verlust der elastischen Fasern. J Dtsch Dermatol Ges 2018; 16:183-191. [DOI: 10.1111/ddg.13430_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 12/03/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Michael Tronnier
- Klinik für Dermatologie; Venerologie und Allergologie; HELIOS Klinikum Hildesheim GmbH; Hildesheim
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13
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Luo DQ, Huang CZ, Shi W, Wang Z, He DY. Local Panatrophy Associated with Pain: A Rare Variant of Local Panatrophy or a New Entity? Chin Med J (Engl) 2017; 130:2515-2516. [PMID: 29052578 PMCID: PMC5684642 DOI: 10.4103/0366-6999.216400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Di-Qing Luo
- Department of Dermatology, The Eastern Hospital of The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510700, China
| | - Chang-Zheng Huang
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China
| | - Wei Shi
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Zhuo Wang
- Department of Pathology, The Eastern Hospital of The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510700, China
| | - Ding-Yang He
- Department of Dermatology, The Eastern Hospital of The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510700, China
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14
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Margerin F, Cribier B. Granulome annulaire élastolytique à cellules géantes : étude anatomoclinique. Ann Dermatol Venereol 2017; 144:589-598. [DOI: 10.1016/j.annder.2017.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 01/13/2017] [Accepted: 03/03/2017] [Indexed: 10/19/2022]
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15
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Middermal Elastolysis: Dermal Fibroblasts Cooperate with Inflammatory Cells to the Elastolytic Disorder. Mediators Inflamm 2017; 2017:9524594. [PMID: 29097850 PMCID: PMC5623776 DOI: 10.1155/2017/9524594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 07/25/2017] [Accepted: 09/05/2017] [Indexed: 12/04/2022] Open
Abstract
Little is known about the cause and pathophysiology of middermal elastolysis (MDE). In this condition, variable inflammatory infiltrate may be present or not together with loss of elastic fibres in the middermis that spares both papillary and lower reticular dermis. MDE may be a consequence of abnormal extracellular matrix degradation related to an imbalance between elastolytic enzymes released from inflammatory and resident cells and their naturally occurring inhibitors. However, the cause of this imbalance is still an object of investigation. In order to shed light on the role of fibroblasts in MDE, we used fibroblast cultures from MDE and control subjects to evaluate matrix metalloproteinases (MMPs) and their major inhibitor TIMP-1, which in combination with neutrophil or macrophage proteases released in inflamed areas may influence the elastolytic burden. We demonstrate that fibroblasts derived from MDE produce in vitro low levels of TIMP-1, the major inhibitor of MMPs. Elevated levels of MMP-2, MMP-14, and TIMP-2 capable to activate in a cooperative manner pro-MMP-2 are present in MDE tissue samples. Additionally, significant reaction for MMP-1 is present in the same MDE areas. These data all together suggest that ECM changes in MDE are due to cooperation of different cell populations (i.e., inflammatory cells and fibroblasts).
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16
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Abstract
Pseudoxanthoma elasticum (PXE) is a genetic metabolic disease with autosomal recessive inheritance caused by mutations in the ABCC6 gene. The lack of functional ABCC6 protein leads to ectopic mineralization that is most apparent in the elastic tissues of the skin, eyes and blood vessels. The clinical prevalence of PXE has been estimated at between 1 per 100,000 and 1 per 25,000, with slight female predominance. The first clinical sign of PXE is almost always small yellow papules on the nape and sides of the neck and in flexural areas. The papules coalesce, and the skin becomes loose and wrinkled. The mid-dermal elastic fibers are short, fragmented, clumped and calcified. Dystrophic calcification of Bruch's membrane, revealed by angioid streaks, may trigger choroidal neovascularization and, ultimately, loss of central vision and blindness in late-stage disease. Lesions in small and medium-sized artery walls may result in intermittent claudication and peripheral artery disease. Cardiac complications (myocardial infarction, angina pectoris) are thought to be relatively rare but merit thorough investigation. Ischemic strokes have been reported. PXE is a metabolic disease in which circulating levels of an anti-mineralization factor are low. There is good evidence to suggest that the factor is inorganic pyrophosphate (PPi), and that the circulating low levels of PPi and decreased PPi/Pi ratio result from the lack of ATP release by hepatocytes harboring the mutant ABCC6 protein. However, the substrate(s) bound, transported or modulated by the ABCC6 protein remain unknown. More than 300 sequence variants of the ABCC6 gene have been identified. There is no cure for PXE; the main symptomatic treatments are vascular endothelial growth factor inhibitor therapy (for ophthalmic manifestations), lifestyle, lipid-lowering and dietary measures (for reducing vascular risk factors), and vascular surgery (for severe cardiovascular manifestations). Future treatment options may include gene therapy/editing and pharmacologic chaperone therapy.
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Affiliation(s)
- Dominique P Germain
- Division of Medical Genetics, University of Versailles - Saint Quentin en Yvelines, Paris-Saclay University, 2 avenue de la source de la Bièvre, F-78180, Montigny, France.
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A Clinicoimmunohistopathologic Study of Anetoderma: Is Protruding Type More Advanced in Stage Than Indented Type? J Immunol Res 2016; 2016:4325463. [PMID: 28116317 PMCID: PMC5225372 DOI: 10.1155/2016/4325463] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 10/19/2016] [Indexed: 11/30/2022] Open
Abstract
Background. The clinical and histopathologic classification of anetoderma are not well characterized. Objective. We aimed to investigate the clinical and histopathologic characteristics of anetoderma and to correlate clinical phenotypes with immunohistopathologic findings. Methods. We retrospectively reviewed the medical records of 30 patients with anetoderma and performed immunohistochemistry for elastin, fibrillin-1, metalloproteinase- (MMP-) 2, MMP-7, MMP-9, and MMP-12, and tissue inhibitor of metalloproteinase- (TIMP-) 1 and TIMP-2. Results. Protruding type (n = 17) had a longer disease duration and more severe loss of elastin, without changes in fibrillin, than indented type (n = 13). MMP-2 and MMP-9 showed significantly higher expressions in the dermis compared with controls (p < 0.05). MMP-7 and MMP-12 showed little expressions in both anetoderma and control tissue. TIMP-1 was highly expressed in anetoderma lesions and controls. TIMP-2 expression was variable. Conclusions. Our findings suggest that protruding type anetoderma may represent a more advanced stage and that MMP-2 and MMP-9 could be responsible for elastic fiber degradation in anetoderma.
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Gambichler T, Skrygan M, Reininghaus L, Schulze HJ, Schaller J, Hessam S, Colato C, Girolomoni G, Heitzer E. Lysyl oxidase-like 2 promoter hypermethylation in mid-dermal elastolysis. Br J Dermatol 2016; 175:1354-1356. [DOI: 10.1111/bjd.14666] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- T. Gambichler
- Department of Dermatology; Ruhr-University Bochum; Bochum Germany
| | - M. Skrygan
- Department of Dermatology; Ruhr-University Bochum; Bochum Germany
| | - L. Reininghaus
- Department of Dermatology; Ruhr-University Bochum; Bochum Germany
| | - H.-J. Schulze
- Fachklinik Hornheide; Skin Cancer Centre; Department of Dermatology and Dermato-Histo-Pathology; Münster Germany
| | | | - S. Hessam
- Department of Dermatology; Ruhr-University Bochum; Bochum Germany
| | - C. Colato
- Section of Pathology; Department of Pathology and Diagnostics; University of Verona; Verona Italy
| | - G. Girolomoni
- Section of Dermatology and Venereology; Department of Medicine; University of Verona; Verona Italy
| | - E. Heitzer
- Institute of Human Genetics; Medical University of Graz; Graz Austria
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[Mid-dermal elastolysis after insertion of a pacemaker]. Ann Dermatol Venereol 2015; 142:680-4. [PMID: 26362130 DOI: 10.1016/j.annder.2015.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 03/17/2015] [Accepted: 07/10/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND Mid-dermal elastolysis (MDE) is a rare acquired disease of elastic tissue histologically characterized by focal loss of elastic fibres within the mid-dermis. While the mechanisms leading to MDE remain unknown, increased degradation of elastic fibres may be involved. Many factors potentially triggering such degradation have been suggested. PATIENTS AND METHODS A 58-year-old man consulted for an asymptomatic reticulated eruption that began in the area of a pacemaker implanted six weeks earlier. The eruption consisted of erythematous polycyclic and coalescing macules with a wrinkled centre. Histopathology with orcein staining revealed focal loss of elastic fibres in the superficial reticular dermis only. Hypersensitivity reaction to any components of the pacemaker was ruled out by means of allergy exploration. Laboratory investigations including autoimmunological and haematological factors were unremarkable. A diagnosis was made of a reticular variant of MDE following insertion of a pacemaker. DISCUSSION We report the second case of MDE following the insertion of a pacemaker, which could have triggered an inflammatory response directed specifically towards the elastic fibres.
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Patterson AT, Beasley KJ, Kobayashi TT. Fibroelastolytic papulosis: histopathologic confirmation of disease spectrum variants in a single case. J Cutan Pathol 2015; 43:142-7. [DOI: 10.1111/cup.12569] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 07/15/2015] [Accepted: 08/02/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Andrew T. Patterson
- Ohio State University College of Medicine; Columbus OH USA
- Department of Dermatology; San Antonio Uniformed Services Health Education Consortium, Lackland Air Force Base; San Antonio TX USA
| | - Knox J. Beasley
- Department of Dermatology; San Antonio Uniformed Services Health Education Consortium, Lackland Air Force Base; San Antonio TX USA
| | - Todd T. Kobayashi
- Department of Dermatology; San Antonio Uniformed Services Health Education Consortium, Lackland Air Force Base; San Antonio TX USA
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Hardin J, Dupuis E, Haber RM. Mid-dermal elastolysis: A female-centric disease; case report and updated review of the literature. Int J Womens Dermatol 2015; 1:126-130. [PMID: 28491975 PMCID: PMC5418881 DOI: 10.1016/j.ijwd.2015.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 05/27/2015] [Accepted: 05/29/2015] [Indexed: 12/03/2022] Open
Abstract
Background Mid-dermal elastolysis (MDE) is a rare, yet well-defined clinical and histopathologic entity manifested by fine wrinkling of the skin and mid-dermal loss of elastic fibers. This disease predominantly affects young to middle-aged Caucasian females and although it has no reported systemic features, it is psychologically bothersome and can be of great cosmetic concern. Methods We report a case of a healthy 45 year-old female with widespread mid-dermal elastolysis. A literature search using the search terms “mid-dermal elastolysis,” “mid dermal elastolysis,” “middermal elastolysis,” and “elastophagocytosis” was conducted on Pubmed, using articles published from January 2008 until November 2014 to accompany Gambichler’s comprehensive 1977 to 2009 review of mid-dermal elastolysis. The references of relevant papers were reviewed and further cases included as appropriate. Results We review the clinical features and histological, ultrastructural, and immunohistochemical findings of MDE, as well as differential diagnoses. There are 13 new publications of MDE since 2008. The novel findings since Gambichler’s review are discussed and pathomechanisms revisited. Interestingly, given the striking female predominance of MDE, there is no known hormonal role in its etiology.
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Affiliation(s)
- Jori Hardin
- Division of Dermatology, University of Calgary, Calgary, Alberta, Canada
| | - Elaine Dupuis
- Division of Dermatology, University of Calgary, Calgary, Alberta, Canada
| | - Richard M Haber
- Division of Dermatology, University of Calgary, Calgary, Alberta, Canada
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Jain N, Rathore BS, Bhardwaj A, Bansal R. Primary anetoderma in a young male involving palms, soles and the scalp: rarest of the rare. Indian J Dermatol 2015; 60:215. [PMID: 25814749 PMCID: PMC4372953 DOI: 10.4103/0019-5154.152605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Primary anetoderma is a rare idiopathic disease of the skin, characterized by circumscribed areas of loose skin, and loss of elastic fibers upon histopathologic examination. Two forms are traditionally distinguished, primary and secondary. Primary anetoderma occurs when there is no underlying associated skin disease, whereas the latter refers to an abnormal repair mechanism of preexisting skin lesions. We are reporting a case of primary anetoderma with lesions present all over the body, including the scalp, palms and soles, the sites that are not known to be involved in this condition.
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Affiliation(s)
- Noopur Jain
- From the Department of Dermatology, Subharti Medical College, Meerut, Uttar Pradesh, India
| | - Bagirath Singh Rathore
- From the Department of Dermatology, Subharti Medical College, Meerut, Uttar Pradesh, India
| | - Abhishek Bhardwaj
- From the Department of Dermatology, Subharti Medical College, Meerut, Uttar Pradesh, India
| | - Rani Bansal
- Department of Pathology, Subharti Medical College, Meerut, Uttar Pradesh, India
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Gambichler T, Reininghhaus L, Schaller J. Early-onset pseudoxanthoma elasticum-like papillary dermal elastolysis. J Eur Acad Dermatol Venereol 2014; 30:448-9. [DOI: 10.1111/jdv.12822] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- T. Gambichler
- Department of Dermatoloy, Venereology and Allergology; Ruhr-University Bochum; Bochum Germany
| | - L. Reininghhaus
- Department of Dermatoloy, Venereology and Allergology; Ruhr-University Bochum; Bochum Germany
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Papular elastorrhexis: report of four cases and review of literature. Arch Dermatol Res 2014; 307:99-108. [DOI: 10.1007/s00403-014-1509-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 09/08/2014] [Accepted: 09/15/2014] [Indexed: 10/24/2022]
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25
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Cota C, Latini A, Lora V, Cerroni L. Mid-dermal elastolysis as a manifestation of immune reconstitution inflammatory syndrome in an HIV-infected patient. J Am Acad Dermatol 2014; 71:e134-5. [PMID: 25219731 DOI: 10.1016/j.jaad.2014.04.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 04/17/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Carlo Cota
- Dermatopathology Unit, San Gallicano Dermatological Institute, Rome, Italy.
| | - Alessandra Latini
- Division of Dermatology, San Gallicano Dermatological Institute, Rome, Italy
| | - Viviana Lora
- Division of Dermatology, San Gallicano Dermatological Institute, Rome, Italy
| | - Lorenzo Cerroni
- Dermatopathology Research Unit, Department of Dermatology, Medical University of Graz, Austria
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26
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Elastophagocytosis: Underlying mechanisms and associated cutaneous entities. J Am Acad Dermatol 2014; 70:934-44. [DOI: 10.1016/j.jaad.2013.12.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 11/21/2013] [Accepted: 12/05/2013] [Indexed: 02/06/2023]
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27
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Increase of elastic fibers in lichen sclerosus et atrophicus. J Cutan Pathol 2014; 41:646-9. [DOI: 10.1111/cup.12342] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 03/06/2014] [Accepted: 03/12/2014] [Indexed: 11/26/2022]
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Abstract
BACKGROUND Light and electron microscopy have not identified a distinct anatomical structure associated with either skin wrinkles or creases, and a histological difference between wrinkled and adjacent skin has not been identified. OBJECTIVES The authors investigate whether facial wrinkles are related to underlying lymphatic vessels and perilymphatic fat. METHODS Lymphatic vessels with a specialized tube of perilymphatic fat were identified beneath palmar creases. Sections of skin, adipose tissue, and muscle were harvested from each of 13 cadavers. Three sites were investigated: the transverse forehead crease, lateral orbicularis oculi wrinkle (crow's feet), and the nasojugal crease. The tissue was paraffin embedded and processed. Two-step indirect immunohistochemistry was performed, and images were examined using laser confocal microscopy. Measurements were taken with software. RESULTS Every wrinkle examined was found above and within ±1 mm of a major lymphatic vessel and its surrounding tube of adipose tissue. The results satisfied our null hypothesis and were statistically significant. Lymphatic vessels were identified by positive immunofluorescence as well as histological criteria. These findings have been further validated by fluorochrome tracer studies. CONCLUSIONS An anatomical basis for wrinkles was identified among the specimens studied. Lymphatic vessels, along with the surrounding distinct perilymphatic fat, traveled directly beneath wrinkles and creases. Lymphatic dysregulation leads to inflammation, scarring, and fibrosis, but inadvertent injection of these vessels can be avoided with anatomical knowledge.
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Affiliation(s)
- Joel E Pessa
- Dr Pessa is a plastic surgeon in private practice in Abilene, Texas
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Lai JHC, Murray SJ, Walsh NM. Evolution of granuloma annulare to mid-dermal elastolysis: report of a case and review of the literature. J Cutan Pathol 2014; 41:462-8. [PMID: 24447045 DOI: 10.1111/cup.12292] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 01/13/2014] [Accepted: 01/19/2014] [Indexed: 10/25/2022]
Abstract
A 55-year-old healthy Caucasian female, on no medication, was seen by a dermatologist because of a patchy, slightly indurated and violaceous eruption involving her neck and trunk. The clinical impression was of granuloma annulare (GA). Over a period of several months the violaceous lesions became atrophic with loss of colour and eventual wrinkling of lesional skin. Sequential skin biopsies were obtained, which revealed a spectrum of changes. Those from early violaceous lesional zones displayed perivascular lymphocytic infiltrates and interstitial granulomatous inflammation, characteristic of interstitial GA. Samples from atrophic lesional areas appeared normal on routine sections but an Orcein-Giemsa (OG) stain, prompted by the clinical history of atrophy, revealed absence of elastic fibers in the mid-reticular dermis. The combined clinicopathologic findings pointed to development of mid-dermal elastolysis (MDE) at involutional sites of GA. Owing to consideration of a cutaneous T-cell lymphoma in the differential diagnosis, genotyping in search of T-cell monoclonality was performed and yielded a negative result. Our case supports the existing but scant evidence in the literature that the rare, enigmatic condition termed MDE is an end-result of inflammatory destruction of dermal elastic fibers. GA is one form of dermatitis capable of culminating in this entity, but others have also been implicated.
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Affiliation(s)
- Jonathan H C Lai
- Division of Anatomical Pathology, Department of Pathology, Capital District Health Authority and Dalhousie University, Halifax, Nova Scotia, Canada
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30
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Connective Tissue/Degenerative Disorders. Dermatopathology (Basel) 2014. [DOI: 10.1007/978-1-4471-5448-8_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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31
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Gambichler T, Skrygan M. Decreased lysyl oxidase-like 2 expression in mid-dermal elastolysis. Arch Dermatol Res 2012; 305:359-63. [DOI: 10.1007/s00403-012-1308-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 12/03/2012] [Accepted: 12/04/2012] [Indexed: 11/28/2022]
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Kazlouskaya V, Malhotra S, Lambe J, Idriss MH, Elston D, Andres C. The utility of elastic Verhoeff-Van Gieson staining in dermatopathology. J Cutan Pathol 2012; 40:211-25. [DOI: 10.1111/cup.12036] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Revised: 10/06/2012] [Accepted: 10/07/2012] [Indexed: 12/17/2022]
Affiliation(s)
| | - Saurabh Malhotra
- Department of Pathology; Dartmouth Hitchcock Medical Center; Hanover; NH; USA
| | | | | | - Dirk Elston
- Ackerman Academy of Dermatopathology; New York; NY; USA
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Meyer A, Aaron D, Perry A, Guill M. Erythematous reticular patches: a rare presentation of mid-dermal elastolysis. J Am Acad Dermatol 2012; 67:e216-7. [PMID: 23062921 DOI: 10.1016/j.jaad.2012.03.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2011] [Revised: 03/28/2012] [Accepted: 03/30/2012] [Indexed: 10/27/2022]
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Posada C, No N, De La Torre C, Flórez A. Reticular variant of mid-dermal elastolysis. Australas J Dermatol 2012; 54:69-71. [PMID: 22780831 DOI: 10.1111/j.1440-0960.2012.00925.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 05/15/2012] [Indexed: 11/29/2022]
Abstract
Mid-dermal elastolysis is a rare disorder characterised by focal loss of elastic tissue in the mid-dermis. Most patients present with lesions of fine wrinkling (type I) or perifollicular papules (type II). The reticular variant (type III) has been described less often in the literature. We report a case of a young woman with type III mid-dermal elastolysis.
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Affiliation(s)
- Celia Posada
- Dermatology Department, Complexo Hospitalario de Pontevedra, Pontevedra, Spain.
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Hagmeister U, Reuschlein K, März A, Wenck H, Gallinat S, Lucius R, Knott A. Poly(A) tail shortening correlates with mRNA repression in tropoelastin regulation. J Dermatol Sci 2012; 67:44-50. [DOI: 10.1016/j.jdermsci.2012.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Revised: 02/16/2012] [Accepted: 03/02/2012] [Indexed: 01/20/2023]
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Gambichler T, Lübbe J. Reticular variant of mid-dermal elastolysis accompanied by persistent urticarial lesions. J Dermatol 2012; 39:963-5. [PMID: 22724522 DOI: 10.1111/j.1346-8138.2012.01596.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Singh S, Tailor A, Carton J, Hewitt C. Premature wrinkling of the skin in a 31-year-old woman. Clin Exp Dermatol 2012; 37:318-9. [PMID: 22409526 DOI: 10.1111/j.1365-2230.2011.04140.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- S Singh
- St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
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Rongioletti F, Izakovic J, Romanelli P, Lanuti E, Miteva M. Pseudoxanthoma elasticum-like papillary dermal elastolysis: a large case series with clinicopathological correlation. J Am Acad Dermatol 2011; 67:128-35. [PMID: 22018757 DOI: 10.1016/j.jaad.2011.09.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Revised: 09/07/2011] [Accepted: 09/11/2011] [Indexed: 10/16/2022]
Abstract
BACKGROUND Pseudoxanthoma elasticum (PXE)-like papillary dermal elastolysis (PDE) is a rare acquired elastic tissue disorder. To date, less than 20 cases have been reported. OBJECTIVE We report a case series of 17 patients presenting with PXE-like PDE and discuss the clinicopathological correlation. METHODS Seventeen cases of PXE-like PDE were collected prospectively and evaluated for common demographic, clinical, and histopathological features. RESULTS All patients were women with a mean age of 61.8 years. The lateral sides and back of neck were the most common sites of involvement (100%), followed by the supraclavicular region (41.2%) and the axilla (35.3%). Systemic involvement was absent in all cases, and in 7 patients the discovery of PXE-like PDE was an incidental finding. The main histopathologic features included complete loss (82.4%) or marked reduction (17.6%) of elastic fibers in the papillary dermis and the presence of melanophages in the same zone (88.2%). LIMITATIONS Our results require validation with a larger series. CONCLUSIONS Our findings help to differentiate PXE-like PDE from similar elastic tissue disorders based on the selective elastic tissue elimination in the papillary dermis and the presence of melanophages in the same zone as a possible consequence of subclinical junctional photodamage. PXE-like PDE is likely underdiagnosed rather than rare, and dermatologists should be aware of its similarity to inherited PXE to spare unnecessary investigations because of the lack of systemic involvement. Clinicopathologic correlation is critical as hematoxylin-eosin staining is nonspecific and elastic tissue stains are necessary to make the correct diagnosis.
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Affiliation(s)
- Franco Rongioletti
- Section of Dermatology and Department of Dermatopathology, University of Genoa, Genoa, Italy.
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Cruz MJ, Barros AM, Azevedo F. Generalized mid dermal elastolysis. Dermatol Reports 2011; 3:e52. [PMID: 25386304 PMCID: PMC4211503 DOI: 10.4081/dr.2011.e52] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Revised: 08/30/2011] [Accepted: 10/24/2011] [Indexed: 11/23/2022] Open
Abstract
Mid-dermal elastolysis (MDE) is a rare skin disorder clinically characterized by the appearance of diffuse fine wrinkling, most often of the trunk and arms. This entity is distinguished from other elastolytic disorders by its characteristic selective loss of elastic fibers of the mid dermis. The aetiopathogenesis of the disease is still unclear as well as the effective treatment. Half of the cases described in the literature are associated with ultraviolet radiation exposure. Other reported triggering conditions such as urticaria, eczema and granuloma annulare suggests different eliciting inflammatory pathways. The authors describe the case of a 38-year-old woman who developed an urticarial eruption during months which progressed to generalized and severe fine wrinkling.
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Affiliation(s)
- Maria João Cruz
- Department of Dermatology and Venereology, Hospital de São João, E.P.E. Porto, Portugal
| | - Ana Margarida Barros
- Department of Dermatology and Venereology, Hospital de São João, E.P.E. Porto, Portugal
| | - Filomena Azevedo
- Department of Dermatology and Venereology, Hospital de São João, E.P.E. Porto, Portugal
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Ruiz V, Fernández-Figueras M, Alomar A. Submammary Perifollicular Papules in a Young Woman. ACTAS DERMO-SIFILIOGRAFICAS 2011. [DOI: 10.1016/j.adengl.2011.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Ruiz V, Fernández-Figueras MT, Alomar A. [Submammary perifollicular papules in a young woman]. ACTAS DERMO-SIFILIOGRAFICAS 2011; 102:541-2. [PMID: 21531363 DOI: 10.1016/j.ad.2011.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Revised: 01/10/2011] [Accepted: 01/19/2011] [Indexed: 11/26/2022] Open
Affiliation(s)
- V Ruiz
- Servicio de Dermatología, Hospital de la Santa Creu i Sant Pau, Barcelona, España.
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Levy-Roy A, Tasei AM, Richard MA. [What is your diagnosis? Mid-dermal elastolysis]. Ann Dermatol Venereol 2011; 138:324-6. [PMID: 21497263 DOI: 10.1016/j.annder.2011.01.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2011] [Accepted: 01/25/2011] [Indexed: 10/18/2022]
Affiliation(s)
- A Levy-Roy
- Cabinet de dermatologie, Le Clos Sévigné, Lambesc, France
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43
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Wagner G, Sachse MM. Elastolysis mediodermalis - case report and review of literature. J Dtsch Dermatol Ges 2011; 9:810-4. [DOI: 10.1111/j.1610-0387.2011.07666.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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44
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Scola N, Goulioumis A, Gambichler T. Non-invasive imaging of mid-dermal elastolysis. Clin Exp Dermatol 2011; 36:155-60. [DOI: 10.1111/j.1365-2230.2010.03864.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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45
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Gambichler T, Stücker M, Kreuter A, Matip R, Gaifullina R, Scola N, Skrygan M. Expression of extracellular matrix proteins in reticular variant of mid-dermal elastolysis. J Eur Acad Dermatol Venereol 2010; 24:1481-4. [DOI: 10.1111/j.1468-3083.2010.03683.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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