Dermal Elastosis Research Articles

Papillary dermal elastosis

We recently came across the article "Papillary dermal elastosis" by Newlove et al published in the October 2011 edition of Dermatology Online Journal. In this paper, the authors described what they interpreted to be the second case of papillary dermal elastosis, an entity we had first identified in 2009. Upon further reading of their histopathologic and clinical description, we believe this case is more consistent with the diagnosis of pseudoxanthoma elasticum-like papillary dermal elastolysis (PXE-PDE).

Validation of skin surface microtopography as a measure of skin photoaging in a subtropical population aged 40 and over

Evidence suggests that skin surface microtopography is a valid measure of photoaging among young adults, but whether this applies to older adults is unknown. We investigated the association between degree of photoaging as measured by histological dermal elastosis and skin microtopography grades by decade of age from 40 to 89 years in a community sample in Australia. Skin surface replicas and punch biopsies were taken from 664 participants of the Nambour Skin Cancer Study. The association was assessed using ordinal logistic regression with proportional odds assumption, using histological dermal elastosis grades as outcome. There was significant increase in odds of higher skin surface microtopography grades with higher dermal elastosis grades for age groups below 70 years [40 to 49 years: odds ratio (OR) 2.96, 95% confidence interval (CI) 1.68-5.22; 50 to 59 years: OR 3.78, 95% CI 2.28-6.26; 60 to 69 years: OR 2.47, 95% CI 1.41-4.35). The association was not significant for those 70 years or older. Skin surface microtopography grading system is a valid measure of degree of dermal elastosis for middle-aged and older adults up to 69 years but appears not to be valid for adults 70 years or more living in a high sun exposure setting.

Familial Acral Localized Late-Onset Focal Dermal Elastosis

Late-onset focal dermal elastosis is a rare disorder of elastic tissue, characterized by a local accumulation of elastic fibers in the mid and deep reticular dermis. This disorder occurs mainly in elderly people and consists of multiple yellow papules that are typically distributed on the sides of the neck and flexural areas, closely resembling pseudoxanthoma elasticum from the clinical point of view. We report 2 sisters who have presented with a 20-year history of multiple yellow papules, mainly located on the dorsum of their hands. They also had few lesions of similar morphology scattered on the anterior aspects of their wrists, thighs, and lower abdomen. Histopathologic study demonstrated a focal increase in thick, interlacing elastic fibers in the mid and deep reticular dermis. The most striking features of our cases were the early age of clinical presentation, the familial involvement, and the predominantly acral distribution of the lesions.

Late-onset focal dermal elastosis

ejd.2012.1664 Auteur(s) : Shan Tian, Zhou Chen chenzhou@medmail.com.cn Department of Dermatology, Peking University People's hospital, 11# Xizhimen South Street, 100044 Beijing, China A 72-year-old woman had a 3-year history of slowly progressing skin lesions on the neck. The patient sometimes felt mild itching but no pain. There was no history of gastric bleeding, coronary disease or stroke, or diminished visual acuity. There was no family history of similar skin lesions. Physical examination revealed multiple, [...]

How do solar UV irradiance and smoking impact the diagnosis of second cancers after diagnosis of melanoma?

It may be useful to look at the risk patterns for developing a second primary malignancy after a first primary melanoma diagnosis in order to understand the etiology and mortality due to melanoma. In this volume, W.B. Grant has proposed the interesting hypothesis that solar UV radiation and smoking may be inversely associated with the development of melanoma through the presence of dermal or solar elastosis. However, this association is inconsistent and may be explained by confounding by outdoor activity, physical exercise, obesity, diet and underlying immune or genetic factors.

Non‐invasive evaluation of dermal elastosis by in vivo multiphoton tomography with autofluorescence lifetime measurements

The non-invasive differentiation of dermal elastic fibres from solar elastosis in vivo is of great interest in dermatologic research, especially for efficacy testing of anti-ageing products. To date, no studies on multiphoton excited fluorescence lifetime characteristics of human elastic fibres and solar elastosis are reported. The goal of the present work was the identification of differential criteria for elastic fibres and solar elastosis by the analysis of fluorescence decay curves acquired by time-correlated single photon counting in vivo multiphoton tomography. For this purpose, fluorescence lifetime measurements (FLIM) were performed with 47 volunteers of different age groups at sun-protected and sun-exposed localizations. Bi-exponential curve fitting was applied to the FLIM data, and characteristic differences between age groups and localizations were found in both relevant fit parameters describing the decay slope. The FLIM analyses have shown that dermal autofluorescence has different lifetimes depending on age and in part on localization.

Relationship between food intake and cutaneous solar elastosis adjacent to basal cell carcinoma

Studies suggest that diet may influence in skin ageing and skin appearance. However, the effect of diet in the elastotic changes of dermis, which is the main histological sign of ageing, has not been studied previously. The objective was to investigate if the dietary habits influence the dermal elastosis observed in BCCs. The 136 patients with facial BCCs, who underwent surgery, were interviewed to assess the consumption of fruit, vegetables, fat, red meat, coffee and tea. We reviewed 136 specimens of BCC to identify the presence of solar elastosis. We also analysed clinical variables such as gender, age, phototype and smoking. Severe solar elastosis was found in 22 patients (16%), middle reticular dermis in 37 (27 %) and 77 patients (57%) had abscence or light elastosis. Fat consumption was reported by most of participants from our sample, while fruit and tea consumption was less common. Intakes of fat, vegetables and coffee were not associated with the grade of elastosis whereas Vitamin E and C-rich fruits and tea were correlated with less risk of elastosis. Smokers showed higher grades of elastosis than non-smokers. Our study provides evidence that the presence of dermal elastosis and cutaneous ageing may be influenced by the type of food intake: Vitamin E and C-rich fruit and tea are positively associated with less elastosis.

Comparison of Histological Measures of Skin Photoaging

Background: Dermal elastosis is considered the histological ‘gold standard’ for evaluation of skin photoaging, but the relation of the level of dermal elastosis to other histological indicators of photoaging is not clear. Objective: To investigate how various proposed histological measures of photoaging compare with the level of dermal elastosis. Methods: Prospective, community-based study in Southeast Queensland, Australia, among 89 participants aged 40–82 years. Quantitative histology was used to evaluate 8 biomarkers of photoaged skin, and associations between grades of dermal elastosis and each of the other 7 biomarkers were analysed using ordinal logistic regression models with proportional odds assumption, using histological grades of elastosis as the outcome. Results: Older age, male sex and high outdoor exposure levels were confirmed as predictors ofhigh levels of dermal elastosis. After adjustment for age and sex, the only significant positive association with increasing elastosis grades was the proportion of p53-positive cells. Epidermal thickness, interdigitation index proportion of surface covered with melanin (% Fontana-Masson staining) and glycosaminoglycan content were not associated with elastosis in either crude or adjusted models. Conclusions: Amonga range of suggested biomarkers of photoaged skin, only p53-positive cells appear to be strongly associated with the level of dermal elastosis.

Papillary dermal elastosis

There are numerous acquired disorders of elastic tissue that are distinguished by a combination of clinical appearance, location, gender, age of onset, and characteristic histopathologic findings. We present a case of a 36-year-old man with multiple confluent, hypopigmented papules that coalesced into plaques with prominent follicular ostia over the dorsal aspects of the forearms, shoulders, upper chest, and upper back. Histologically there was selective loss of papillary dermal elastic fibers. The clinical and histopathologic findings in this case are consistent with an acquired disorder of elastic tissue which we believe represents the second reported case of papillary dermal elastosis.

Linear Focal Elastosis Following Striae Distensae: Further Evidence of Keloidal Repair Process in the Pathogenesis of Linear Focal Elastosis

Linear focal elastosis (LFE) is a rare dermal elastosis characterized by hypertrophic yellowish linear plaques and increased abnormal elastic tissues in the lumbosacral area. Although the pathogenesis of this disorder remains unknown, it may be associated with keloidal repair process (KRP) of elastic tissues in striae distensae (SD), because there have been some reported cases of LFE accompanied by SD. We herein report a 14-year-old boy with LFE following SD in the lumbar region. Our case supports the hypothesis of KRP in the pathogenesis of LFE. Immunohistochemical study for transforming growth factor-beta (TGF-β) was negative. Therefore, we assume that the pathogenesis of KRP in LFE is different from that of keloid development, which is the TGF-β signaling pathway.

A randomized and controlled trial about the use of oral isotretinoin for photoaging

Topical retinoids are used to treat photoaging; oral isotretinoin is gold standard for acne; "off label" indications, including photoaging, have been reported with insufficient evidence of efficacy. This is a randomized controlled phase II trial with clinical and histological assessment to evaluate efficacy and safety of oral isotretinoin for photoaging. Study population was comprised of 32 menopausal or sterilized women, aged 40-55, divided in 2 groups: A (21) received 20mg isotretinoin, 3 times per week, nightly moisturizer, and daily sunscreen, for three months; B (11) just moisturizer/sunscreen. Main outcome measures were: overall clinical assessment; profilometry, corneometer and elasticity tests in periocular regions and left forearm; before/after biopsies from left forearm in patients of B and in 10 randomly selected of A. Microscopic blinded evaluation of epidermal thickness, dermal elastosis, new collagen, p53 epidermal expression was performed by quantitative digital image analysis. All data were submitted to statistical analysis. Clinical evaluation showed slight improvement; profilometry, corneometer and skin elasticity tests presented significant difference in pre/post values (P = 0.001 to 0.028), but no differences between A/B. Histological findings and p53 expression were comparable between groups before treatment (P > 0.1); microscopic analysis showed no differences between groups for most variables, after treatment. Slight but significant difference between A/B for p53 with major reduction post isotretinoin [0.66+/-0.31 vs. 0.94+/-0.34 respectively (P = 0.04) was observed. There were minor side effects and no significant laboratory test alterations. We concluded that no significant clinical, microscopic changes but p53 epidermal expression reduction were observed. The role of ultra-violet induced p53 mutation in skin carcinogenesis reinforces retinoids chemoprevention. Oral isotretinoin seemed safe but not effective to treat photoaging. Caution should be considered for women prone to pregnancy. Further controlled studies are necessary.

Papillary dermal elastosis: a unique elastic tissue disorder or an unusual manifestation of pseudoxanthoma elasticum‐like papillary dermal elastolysis?

There are numerous acquired elastic tissue disorders, several of which present cutaneously with small yellow-to-white papules resembling plucked chicken skin. Differential diagnoses depend on the abnormalities within the network of elastic tissues. We report a case with distinct histologic features, which may represent a unique elastic tissue disorder or a variant of pseudoxanthoma elasticum-like papillary dermal elastolysis. Our patient's clinical presentation includes scattered 1-2 mm white-to-yellow papules without surface change on the upper back and neck region. Histology is characterized by foci of clumped, granular elastic tissue, which have replaced the oxytalan and elaunin fibers, alternating with foci of decreased concentrations of normal-appearing elastic fibers within the papillary dermis. Given its characteristics, we have termed this novel entity 'papillary dermal elastosis'.

Histologic Study of the Structural Changes in Fine Palpebral Skin Following Selective Photothermolysis with CO2 Laser

Resurfacing using a CO(2) laser is a modern and efficient mean to treat facial wrinkles and aging. It is based on the precise vaporization of the most superficial skin layers. This study evaluated the histologic effects of the CO(2) laser on palpebral skin. Twenty-six patients were selected (22 females, 4 males). Their age varied from 43 to 72 years and, of these, 19 were classified as Fitzpatrick type III and 7 as Fitzpatrick type II. The superior palpebral skin was examined before the operation and 3 months, 6 months, 1 year, and 2 years after selective photothermolysis. All the postoperative evaluations showed consistent dermal and epidermal histologic modifications, with the epidermal regeneration showing a normalized anatomy, principally in the evaluations made after approximately 1 year. The dermis presents a dramatic neocollagenous transformation in the superficial and middle dermis, as well as intense modification (restructuring) of the elastic fiber system and reduction in the glycosaminoglycans. Both passes of the laser were analyzed and also the complete healing process. Resurfacing of the fine palpebral skin using two passes at 300 and 200 mJ produces an accentuated collagen neoformation and correction of the dermal elastosis, in association with a rapid healing process.

Photoageing: mechanism, prevention and therapy

Photoageing is the superposition of chronic ultraviolet (UV)-induced damage on intrinsic ageing and accounts for most age-associated changes in skin appearance. It is triggered by receptor-initiated signalling, mitochondrial damage, protein oxidation and telomere-based DNA damage responses. Photodamaged skin displays variable epidermal thickness, dermal elastosis, decreased/fragmented collagen, increased matrix-degrading metalloproteinases, inflammatory infiltrates and vessel ectasia. The development of cosmetically pleasing sunscreens that protect against both UVA and UVB irradiation as well as products such as tretinoin that antagonize the UV signalling pathways leading to photoageing are major steps forward in preventing and reversing photoageing. Improved understanding of the skin's innate UV protective mechanisms has also given rise to several novel treatment concepts that promise to revolutionize this field within the coming decade. Such advances should not only allow for the improved appearance of skin in middle age and beyond, but also greatly reduce the accompanying burden of skin cancer.

Expression of apoptotic, cell proliferation regulatory, and structural proteins in actinic keratosis and their association with dermal elastosis

Actinic keratosis (AK) is a premalignant lesion caused by ultraviolet (UV) radiation and characterized by epithelial and connective tissue alterations. However, little is known about the link between connective and UV-damaged epithelial tissues in AK. To examine the potential relationship between connective tissue degeneration and molecular alterations in epithelial cells without evident morphologic changes, 30 cases of AK (8, grade I; 10, grade II; 12, grade III), divided into three grades according to the proportion of dermal elastosis (in grade I, up to 30% of collagen degeneration; in grade II, 30-60%; in grade III, more than 60%), were immunohistochemically analyzed for the expression of Ki67, p53, p63, bcl-2, E-cadherin, 34-betaE12, and CD99. The increase in the solar elastosis grade was associated with an increase in positive cell numbers for all analyzed markers. Basal expression predominated in the lesions with low and moderate levels of connective tissue degeneration, while a basal and suprabasal expression pattern was prevalent in the lesions with high degeneration. In grade I and II lesions, proliferation marker, Ki67, expression was found to be significantly associated with the proapoptotic marker p53, while in grade III lesions, its expression was correlated with the anti-apoptotic marker, bcl-2. These results demonstrate that the epithelial expression of apoptotic, cell proliferation, and structural proteins is augmented with the increase of the solar elastosis grade. Thus, the grade of solar elastosis could be a helpful morphologic marker in the assessment of neoplastic changes in sun-damaged skin.

Expression of apoptotic, cell proliferation regulatory, and structural proteins in actinic keratosis and their association with dermal elastosis

Expression of apoptotic, cell proliferation regulatory, and structural proteins in actinic keratosis and their association with dermal elastosis

Dermal elastosis in hairless mice after UV-B and UV-A applied simultaneously, separately or sequentially.

The elastosis-inducing capacity of UV-A and UV-B was studied in the skin of hairless mice. After irradiation with UV-B and UV-A applied either simultaneously, separately or sequentially, the degree of elastosis in the dermis was microscopically evaluated. This semi-quantitative method showed no significant elastosis in the UV-A irradiated mice, and moderate elastosis in the UV-B irradiated mice. Heavy elastosis was observed when the mice were exposed sequentially to UV-B and a large dose of UV-A, but if a moderate dose of UV-A was given simultaneously with UV-B, the degree of elastosis was slightly reduced compared with the elastosis induced by UV-B alone.

Sun exposure and host phenotype as predictors of cutaneous melanoma associated with neval remnants or dermal elastosis

Recent research suggests that cutaneous melanomas may arise through 2 distinct pathways, characterized by chronic sun exposure on one hand and nevus-prone phenotype of the host on the other. Two histological characteristics of melanoma consistent with these divergent origins are dermal elastosis in adjacent skin and neval remnants contiguous with the tumor, respectively. To further explore causal heterogeneity in melanoma, we compared sun exposure histories and phenotypic characteristics among a population-based sample of patients newly diagnosed with cutaneous melanoma with and without contiguous neval remnants or dermal elastosis. Tissue blocks were obtained for 141 patients: 53 with superficial spreading melanoma (SSM) of the back, 42 with SSM of head and neck (H & N), and 39 and 7 with lentigo maligna/lentigo maligna melanoma (LM/LMM) of the H & N and back, respectively. Melanomas of the H & N were less likely than those on back to have neval remnants (adjusted OR 0.6, 95% CI 0.3-1.4), but were significantly more likely to have dermal elastosis (adjusted OR 9.3, 95% CI 3.5-25). In site-specific analyses, we found that H & N melanomas with neval remnants were more likely than those without neval remnants to arise in people with more than 60 nevi (adjusted OR 2.1, 95% CI 0.3-14.3), but were less likely to arise in those with more than 20 actinic keratoses. Less marked associations were observed for melanomas of the back. High levels of sun exposure strongly predicted dermal elastosis for H & N melanomas (OR 22.5, 95% CI 2.1-245), but not for melanomas of the back (OR 2.1, 95% CI 0.4-11). We conclude that melanomas with different histologic characteristics have different risk factor profiles, particularly on the head and neck. These data accord with the hypothesis that melanomas arise through different causal pathways.

Skin surface topography grading is a valid measure of skin photoaging

The technique of grading the surface topography of sun-exposed skin using silicone impressions of the skin surface is a simple, non-invasive method for measuring skin damage because of sun exposure, but it has never been validated in a community setting. To investigate the repeatability and validity of using standardly-graded skin impressions as a means of assessing skin photoaging. A random sample of 195 adults aged 18-79 years and living in Nambour, Australia (latitude, 26 degrees South) had a silicone impression taken of the back of the left hand and a 2 mm punch biopsy of the skin at the same site. Silicone impressions were graded twice independently and histological photoaging was determined by two pathologists. Grading of silicone impressions of skin surface topography was highly repeatable (weighted kappa > 0.8). Compared with those with low skin impression grades (least degeneration), people with high grades were three times more likely to show a high degree of dermal elastosis on skin histology (odds ratio 3.1, 95% confidence interval 1.6, 5.7) after adjusting for age, sex, skin colour, tanning ability, occupational exposure, smoking and height-adjusted weight. Other photoaging changes in the stratum corneum and dermis were also strongly correlated with high grades of damage on skin impressions. Grading silicone impressions of skin surface topography is a highly reliable and a valid measure of photoaging and enables prediction of dermal elastosis in a population setting.

Melanocytic nevi are associated with neurofibromas in neurofibromatosis, type I, but not sporadic neurofibromas. A study of 226 cases*

Neurofibromatosis, type 1, is associated with cutaneous melanin pigmentation, but an association with ordinary melanocytic nevi has not been described. This retrospective case-control study was designed to see if neurofibromas in patients with neurofibromatosis, type 1 (NF-1) differ from sporadic neurofibromas (SN) in their incidence of associated melanocytic nevi and other histologic features. Slides from 114 NF-1 were compared with 112 SN and 300 intradermal melanocytic nevi (IDN). Small lentiginous melanocytic nevi were identified over 13 NF-1 (11%) but no SN (P=0.0002). Compared with other NF-1, NF-1 with nevi were more frequently associated with melanocytic hyperplasia, giant melanosomes and diffuse neurofibroma (P<0.03). Compared with SN, NF-1 were also more frequently associated with melanocytic hyperplasia, lentigo simplex-like changes, diffuse neurofibroma and plexiform neurofibroma (P<0.001). Sebaceous hyperplasia (14%), dermal elastosis (9%), lipomatous change (8%), epithelial cysts (4%) and keratin granulomas or folliculitis (3%) were not significantly different in prevalence between NF-1, SN and the control group of IDN. This study suggests that there is a difference in the potential for melanocytic proliferation in NF-1 compared with SN. NF-1, SN and IDN are associated with a similar range of incidental histologic changes. Ball NJ, Kho GT. Melanocytic nevi are associated with neurofibromas in neurofibromatosis, type 1, but not sporadic neurofibromas. A study of 226 cases.