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

A Case Report on Mid-Dermal Elastolysis: A Distinctive Presentation on the Neck

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.

SAPHO Syndrome Presenting With Atlo-Epistrophic Synovitis and Left Vocal Cord Paresis: A Challenging Diagnosis

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.

A Brief Literature Update on Mid-dermal Elastolysis with an Emphasis on Pathogenetic and Therapeutic Aspects

We provide a brief review on mid-dermal elastolysis (MDE) and summarize clinical data of 105 patients with MDE who were reported in the literature since the disease was first described in 1977. In doing so, emphasis is placed on pathomechanisms and therapeutic aspects. MDE is a rare, acquired skin disease histopathologically characterized by selective loss of elastic fibers in the mid-dermis. Lesions are commonly observed on the trunk and proximal extremities. These include well-circumscribed patches of fine wrinkles, perifollicular papular protrusions, and persistent reticular erythema. With respect to pathomechanisms, current data suggest that different cell types (e.g., macrophages, fibroblasts) might chronically overexpress matrix metalloproteinases resulting in an enhanced elastolytic activity. Together with decreased expression of the tissue inhibitors of metalloproteinases, this is thought to result in zonal degradation and loss of elastic tissue in the mid-dermis. However, the exact mechanisms leading to the enhanced elastolytic activity in MDE remain elusive. A multifactorial pathogenesis is likely, including genetic predisposition, chronic inflammation, and (auto)immune processes. Moreover, the capacity for elastic fiber renewal appears to be diminished in patients with MDE, limiting regenerative potential and informing possible treatment strategies, for example, by stimulating elastic fiber synthesis. Although the course of MDE is usually benign and asymptomatic, it can cause severe cosmetic problems. Hence, new therapeutic approaches that block increased elastolytic activity and enhance regeneration of elastic tissue observed in MDE patients are required.

Cutaneous disorders characterized by elastolysis or loss of elastic tissue

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.

Late-Onset Facial Papular Elastorrhexis

Papular elastorrhexis, a rare defect of dermal elastic fibers of unknown origin, usually involves the trunk and extremities of children or young adults. We report the case of a 62-year-old woman with multiple soft, skin-colored facial papules with histological findings characteristic of papular elastorrhexis. Awareness of this entity may allow for its proper identification outside the usual clinical setting.

Mycophenolate mofetil to treat mid-dermal elastolysis

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.