Acquired idiopathic cutaneous elastolysis of the papillary and mid-dermis: Distinct but related conditions. Report of two cases

Among the acquired idiopathic cutaneous elastolytic disorders, pseudoxanthoma elasticum-like papillary dermal elastolysis (PDE) and mid-dermal elastolysis (MDE) are conditions not frequently reported in the literature. We report 2 cases: the first an older woman with typical papular and plaque-like lesions on both sides of her neck and shoulders and the second a 42-year-old woman with fine wrinkles scattered all over the trunk, shoulders and abdomen. Histological examination of the first case revealed loss of the elastic fibers limited to the papillary dermis, instead in the second case the loss was observed in the mid-dermis. We discuss the possibility that PDE and some cases of non-inflammatory MDE may represent distinct but related entities in a 'spectrum' of acquired elastolysis and that they may be an expression of intrinsic aging.