THE CLINICAL SPECTRUM OF MID-DERMAL ELASTOLYSIS AND THE ROLE OF UV-LIGHT IN ITS PATHOGENESIS

Background: We observed four patients with mid-dermal elastolysis (MDE ) that was either precipitated or aggravated by UV light (UVL) exposur e or was primarily confined to areas of UVL exposure. Objective. Our p urpose was to report four cases of MDE occurring after significant UVL exposure and to demonstrate why we suspect that MDE in some instances may be photoinduced or photoaggravated. We also wish to demonstrate t he varied clinical presentation of this disorder. Methods. Because all our patients had MDE involving skin exposed to UVL, biopsies were per formed on clinically uninvolved sun-exposed and sun-protected skin in one patient to elucidate further the role of UVL in this process. Resu lts: On routine histopathologic examination we found that uninvolved s un-exposed skin but not sun-protected skin demonstrated early MDE. Ult rastructural examination revealed a spectrum of elastic fiber changes in involved and clinically uninvolved sun-exposed skin. Phagocytosis o f elastic fibers was not present. Conclusion: We conclude that UVL exp osure was a major causative or aggravating factor of MDE in our patien ts and that the clinical appearance of this disorder is variable.