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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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3
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Panagou E, Ratynska M, Heelan K. Pseudoxanthoma elasticum‐like papillary dermal elastolysis: a case report and review of literature. Int J Dermatol 2018; 58:93-97. [DOI: 10.1111/ijd.14093] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 05/11/2018] [Accepted: 05/22/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Evangelia Panagou
- Department of Dermatology University College London Hospital London UK
| | - Marzena Ratynska
- Department of Histopathology University College London Hospital London UK
| | - Kara Heelan
- Department of Dermatology University College London Hospital London UK
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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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Vázquez-Osorio I, Rosón E, Suárez-Peñaranda J, Vázquez-Veiga H. Pseudoxanthoma Elasticum–like Papillary Dermal Elastolysis. ACTAS DERMO-SIFILIOGRAFICAS 2015. [DOI: 10.1016/j.adengl.2015.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Vázquez-Osorio I, Rosón E, Suárez-Peñaranda J, Vázquez-Veiga H. Elastólisis de la dermis papilar similar a pseudoxantoma elástico. ACTAS DERMO-SIFILIOGRAFICAS 2015; 106:333-6. [DOI: 10.1016/j.ad.2014.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 09/29/2014] [Accepted: 10/02/2014] [Indexed: 10/24/2022] Open
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Pranteda G, Muscianese M, Marmo G, Fidanza L, Pranteda G, Tamburi F, Bottoni U, Nisticò S. Role of Steroid Therapy in Pseudoxanthoma Elasticum-like Papillary Dermal Elastolysis. Int J Immunopathol Pharmacol 2013; 26:1013-8. [DOI: 10.1177/039463201302600423] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Pseudoxanthoma Elasticum-like Papillary Dermal Elastolysis (PXE-PDE) is a peculiar idiopathic elastolytic disorder that clinically resembles Psudoxanthoma elasticum (PXE). It is histologically characterized by a total or partial loss of elastic fibers in the papillary dermis. It more often affects elderly women and is characterized by asymptomatic and symmetrical yellowish papules localized predominantly on the neck, supraclavicular regions, and flexural areas. After analyzing a series of cases and the recent literature suggesting that glucocorticoids may down-regulate the elastin gene expression and elastin mRNA, in cultured human skin fibroblasts, we think that high dose and prolonged steroid therapy may contribute to the appearance of PXE-PDE lesions.
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Affiliation(s)
- G. Pranteda
- Dermatology Unit, NESMOS Department, II School of Medicine, Sapienza University Rome, “S. Andrea Hospital” Rome, Italy
| | - M. Muscianese
- Dermatology Unit, NESMOS Department, II School of Medicine, Sapienza University Rome, “S. Andrea Hospital” Rome, Italy
| | - G. Marmo
- Dermatology Unit, NESMOS Department, II School of Medicine, Sapienza University Rome, “S. Andrea Hospital” Rome, Italy
| | - L. Fidanza
- Dermatology Unit, NESMOS Department, II School of Medicine, Sapienza University Rome, “S. Andrea Hospital” Rome, Italy
| | - G. Pranteda
- Dermatology Unit, Faculty of Medicine, Umberto I Hospital, Sapienza University, Rome, Italy
| | - F. Tamburi
- Dermatology Unit, Complesso Integrato Columbus, Catholic University of Rome, Italy
| | - U. Bottoni
- Dermatology Unit, Department of Health Sciences University Magna Graecia of Catanzaro, Italy
| | - S. Nisticò
- Dermatology Unit, Department of Health Sciences University Magna Graecia of Catanzaro, Italy
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Hosen MJ, Lamoen A, De Paepe A, Vanakker OM. Histopathology of pseudoxanthoma elasticum and related disorders: histological hallmarks and diagnostic clues. SCIENTIFICA 2012; 2012:598262. [PMID: 24278718 PMCID: PMC3820553 DOI: 10.6064/2012/598262] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 07/08/2012] [Indexed: 06/02/2023]
Abstract
Among ectopic mineralization disorders, pseudoxanthoma elasticum (PXE)-a rare genodermatosis associated with ocular and cardiovascular manifestations-is considered a paradigm disease. The symptoms of PXE are the result of mineralization and fragmentation of elastic fibers, the exact pathophysiology of which is incompletely understood. Though molecular analysis of the causal gene, ABCC6, has a high mutation uptake, a skin biopsy has until now been considered the golden standard to confirm the clinical diagnosis. Although the histological hallmarks of PXE are rather specific, several other diseases-particularly those affecting the skin-can present with clinical and/or histological characteristics identical to or highly resemblant of PXE. In this paper, we will summarize the histopathological features of PXE together with those of disorders that are most frequently considered in the differential diagnosis of PXE.
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Affiliation(s)
- Mohammad J. Hosen
- Center for Medical Genetics, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
- Department of Genetic Engineering and Biotechnology, Shahjalal University of Science and Technology, Sylhet 3114, Bangladesh
| | - Anouck Lamoen
- Center for Medical Genetics, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
| | - Anne De Paepe
- Center for Medical Genetics, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
| | - Olivier M. Vanakker
- Center for Medical Genetics, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
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Pseudoxanthoma elasticum papillary dermal elastolysis: a case report. Dermatol Res Pract 2010; 2010. [PMID: 20827433 PMCID: PMC2934769 DOI: 10.1155/2010/352724] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2010] [Accepted: 07/11/2010] [Indexed: 11/17/2022] Open
Abstract
PXE-PDE is a rare clinicopathological entity with few cases reported. It affects more often elderly women and is characterized by asymptomatic bilateral and symmetrical yellowish papules localized predominantly on the neck and supraclavicular regions. It is clinically similar to Pseudoxanthoma Elasticum. The authors report a case of a 64-year-old woman presenting asymptomatic, yellowish, non-follicular papules, affecting the occipital and the posterior region of the neck for 1 year. The patient denied pruritic or inflammatory changes, marked solar exposition or trauma on the affected areas. Routine laboratory studies: thoracic x-ray and ophthalmologic examination were normal. The histopathologic examination of a biopsy of one of the cutaneous lesions showed an absence of elastic fibers in the papillary dermis.The diagnosis of Pseudoxanthoma Elasticum-like Papillary Dermal Elastolysis (PXE-PDE) was made. Of great importance is the differential diagnosis with Pseudoxanthoma elasticum (PXE), but we have also to consider other elastolytic disorders: mid-dermal elastolysis (MDE), linear focal elastosis (LFE) and white fibrous papulosis of the neck (WFPN). Until know, there is no effective treatment for this pathology.
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Wang AR, Lewis K, Lewis M, Robinson-Bostom L. Papillary dermal elastosis: a unique elastic tissue disorder or an unusual manifestation of pseudoxanthoma elasticum-like papillary dermal elastolysis? J Cutan Pathol 2009; 36:1010-3. [DOI: 10.1111/j.1600-0560.2008.01183.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Elastólisis dérmica papilar similar a seudoxantoma elástico: presentación de un caso y revisión de la literatura. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/s0213-9251(09)70126-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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13
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Byun JY, DO MO, Kim SH, Choi HY, Myung KB, Choi YW. Pseudoxanthoma elasticum-like papillary dermal elastolysis developed in early middle age. J Dermatol 2007; 34:709-11. [PMID: 17908144 DOI: 10.1111/j.1346-8138.2007.00365.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Pseudoxanthoma elasticum-like papillary dermal elastolysis is a rare acquired elastolytic disorder characterized by papules that resemble pseudoxanthoma elasticum, and it typically affects elderly women. Histopathological examination shows atrophic epidermis and band-like loss of elastic tissue in the papillary dermis. The pathogenesis is assumed to be related to intrinsic aging because it affects elderly people and shows the loss of elastic tissue. We report a case of pseudoxanthoma elasticum-like papillary dermal elastolysis in early middle age presenting typical clinical and histopathological findings. The patient was a 41-year-old woman who had had her lesions for 10 years. We propose that younger patients, hitherto unknown, can be affected by this disorder and suggest that mechanisms other than intrinsic aging are involved in its pathogenesis.
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Affiliation(s)
- Ji-Yeon Byun
- Department of Dermatology, College of Medicine, Ewha Womans University, Seoul, Korea
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14
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Pitarch G, Torrijos A, García-Melgares ML, Roche E, Calatayud A, Fortea JM. [Papillary dermal elastolysis similar to pseudoxanthoma elasticum]. ACTAS DERMO-SIFILIOGRAFICAS 2006; 97:131-3. [PMID: 16595116 DOI: 10.1016/s0001-7310(06)73365-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Papillary dermal elastolysis similar to pseudoxanthoma elasticum is an elastolytic disorder characterized by cutaneous lesions on the neck and in the supraclavicular region that are clinically similar to pseudoxanthoma elasticum, with no systemic complications. The histological examination shows a loss of elastic fibers in the papillary dermis. We report a case in a 76-year-old woman with typical lesions on the neck.
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Affiliation(s)
- Gerard Pitarch
- Servicio de Dermatología, Hospital General Universitario de Valencia, Spain.
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Jagdeo J, Ng C, Ronchetti IP, Wilkel C, Bercovitch L, Robinson-Bostom L. Fibroelastolytic papulosis. J Am Acad Dermatol 2004; 51:958-64. [PMID: 15583589 DOI: 10.1016/j.jaad.2004.06.038] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jared Jagdeo
- Department of Dermatology, Rhode Island Hospital/Brown Medical School, Providence, RI 02903, USA
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Lewis KG, Bercovitch L, Dill SW, Robinson-Bostom L. Acquired disorders of elastic tissue: Part II. decreased elastic tissue. J Am Acad Dermatol 2004; 51:165-85; quiz 186-8. [PMID: 15280835 DOI: 10.1016/j.jaad.2004.03.016] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Elastic fibers in the extracellular matrix are integral components of dermal connective tissue. The resilience and elasticity required for normal structure and function of the skin are attributable to the network of elastic tissue. Advances in our understanding of elastic tissue physiology provide a foundation for studying the pathogenesis of elastic tissue disorders. Many acquired disorders are nevertheless poorly understood owing to the paucity of reported cases. Several acquired disorders in which loss of dermal elastic tissue produces prominent clinical and histopathologic features have recently been described, including middermal elastolysis, papular elastorrhexis, and pseudoxanthoma-like papillary dermal elastolysis, which must be differentiated from more well-known disorders such as anetoderma, acquired cutis laxa, and acrokeratoelastoidosis. Learning objective At the conclusion of this learning activity, participants should have an understanding of the similarities and differences between acquired disorders of elastic tissue that are characterized by a loss of elastic tissue.
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Affiliation(s)
- Kevan G Lewis
- Department of Dermatology, Brown Medical School-Rhode Island Hospital, Providence, RI 02903, USA
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Akagi A, Tajima S, Kawada A, Ishibashi A. Coexistence of pseudoxanthoma elasticum-like papillary dermal elastolysis and linear focal dermal elastosis. J Am Acad Dermatol 2002; 47:S189-92. [PMID: 12140459 DOI: 10.1067/mjd.2002.108495] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
An 89-year-old Japanese woman had pseudoxanthoma elasticum-like papillary dermal elastolysis on the neck and linear focal elastosis on the flexor aspects of the legs and thighs. The lesions of both diseases had similar histologic patterns-loss of elastic fibers in the papillary dermis and accumulation of normal-appearing elastic fibers in the subpapillary or mid dermis. Immunohistochemical analysis showed elastin, and microfibril-associated proteins (fibrillin 1 and 2 and microfibril associated glycoprotein 1 and 4) were absent or decreased in the papillary dermis and present in the accumulated elastic fibers in both lesions. The association of 2 diseases on different areas of the same patient and histologic and immunohistologic similarities between the diseases suggest that, despite the clinical differences, both diseases are closely related.
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Affiliation(s)
- Atsushi Akagi
- Department of Dermatology, National Defense Medical College, Saitama, Japan
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Toll Abelló A, Pujol Vallverdú RM, Alomar Muntañola A, Randazzo L, Matías-Guiu X, Lloreta Trull J. Papulosis fibroelastolítica del cuello. ¿Es la elastólisis de la dermis papilar un hallazgo histopatológico característico? ACTAS DERMO-SIFILIOGRAFICAS 2002. [DOI: 10.1016/s0001-7310(02)76595-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Tajima S, Ohnishi Y, Akagi A, Sasaki T. Elastotic change in the subpapillary and mid-dermal layers in pseudoxanthoma elasticum-like papillary dermal elastolysis. Br J Dermatol 2000; 142:586-8. [PMID: 10777279 DOI: 10.1046/j.1365-2133.2000.03399.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Two patients, aged 72 and 69 years, had skin lesions clinically resembling pseudoxanthoma elasticum (PXE). On histologic examination, the lesions showed an increased accumulation of normal-appearing elastic fibers lacking the abnormalities that characterize PXE. Similar lesions have been described previously in two elderly patients by Tojima et al. (1995). The clinical and histologic differential diagnosis of these lesions is discussed, and it is concluded that they represent a clinicopathologic entity with undetermined prevalence and etiopathogenesis.
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Affiliation(s)
- C Limas
- Department of Anatomical Pathology, The Andreas Syngros Hospital, Athens, Greece
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Ohnishi Y, Tajima S, Ishibashi A, Inazumi T, Sasaki T, Sakamoto H. Pseudoxanthoma elasticum-like papillary dermal elastolysis: report of four Japanese cases and an immunohistochemical study of elastin and fibrillin-1. Br J Dermatol 1998; 139:141-4. [PMID: 9764167 DOI: 10.1046/j.1365-2133.1998.02332.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report four patients with pseudoxanthoma elasticum-like papillary dermal elastolysis (PDE). Multiple small papules on the neck, clinically resembling pseudoxanthoma elasticum, and loss of the elastic fibre network in the papillary dermis were found in each case. Immunohistochemical staining for elastin and fibrillin-1 in one patient demonstrated the disappearance of elastin and fibrillin-1 in the papillary dermis. Site-matched normal skins of the elderly showed intact elastin but a lack of fibrillin-1 in the papillary dermis. The younger normal skins revealed intact elastin and fibrillin-1. The results suggest that fibrillin-1 is absent from the papillary dermis of the normal-appearing neck skin of the elderly and that the primary defect in PDE may be in elastin rather than in fibrillin-1.
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Affiliation(s)
- Y Ohnishi
- Department of Dermatology, National Defense Medical College, Saitama, Japan
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Balus L, Amantea A, Donati P, Fazio M, Giuliano MC, Bellocci M. Fibroelastolytic papulosis of the neck: a report of 20 cases. Br J Dermatol 1997. [PMID: 9349351 DOI: 10.1046/j.1365-2133.1997.18711957.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The clinical and histological features of the entities known as 'white fibrous papulosis of the neck' (WFPN) and 'acquired elastolysis of the papillary dermis simulating pseudoxanthoma elasticum' (PDE) are not clearly defined. This study was conducted to compare our experience of WFPN/PDE with those described in the literature. Twenty patients presented at our institution with papular eruptions involving the neck. The asymptomatic lesions, which ranged in colour from normal skin tones to yellowish, were isolated or coalescent. Microscopically, the papules showed elastolysis and fibrosis of the upper reticular and papillary dermis. A review of the literature shows similar characteristics in cases reported as WFPN and PDE. This study indicates that WFPN and PDE are variants of a single disorder that can be more precisely defined as 'fibroelastolytic papulosis of the neck' and which appears to be a manifestation of intrinsic skin ageing.
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Affiliation(s)
- L Balus
- Laboratory of Dermatopathology, San Gallicano Institute of Dermatology, Rome, Italy
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BALUS L, AMANTEA A, DONATI P, FAZIO M, GIULIANO M, BELLOCCI M. Fibroelastolytic papulosis of the neck: a report of 20 cases. Br J Dermatol 1997. [DOI: 10.1111/j.1365-2133.1997.tb03760.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Rebora A, Parodi A, Rongioletti F. Mid-dermal elastolysis and pseudoxanthoma elasticum-like papillary dermal elastolysis. Br J Dermatol 1995; 132:487. [PMID: 7718476 DOI: 10.1111/j.1365-2133.1995.tb08693.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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