A case of mid-dermal elastolysis after narrowband ultraviolet B phototherapy

Abstract

Conflict of interest: none declared. Mid‐dermal elastolysis (MDE) is a rare disorder first described in 1977, which usually presents clinically with circumscribed areas of fine skin wrinkling and histologically with a band of elastin loss in the mid dermis.1 The pathogenesis of MDE is unknown but several theories have been proposed, including actinic damage to elastin fibres.2 We report a 32‐year‐old woman who developed mid‐dermal elastolysis after receiving narrowband ultraviolet (UV) B phototherapy for a first episode of guttate psoriasis. She had no preceding history of photosensitivity and had Fitzpatrick type II skin. She reported previous use of sun beds: 10 sessions over a period of 1 year, which took place 2 years before presentation. She had no other medical problems and was not taking any medication. She had not taken any recent holiday in a sunny climate. The patient had received 25 UVB treatments, with a cumulative dose of 14.37 J/cm2, resulting in almost complete remission of the psoriasis. Apart from mild facial erythema there were no other episodes of erythema or burning during the course. Four weeks after completion of the course, she presented with an asymptomatic arcuate line of erythema across the shoulders and chest. Fine wrinkling was evident within this line of erythema (Fig. 1).