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

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.