Dermatology Online Journal

Letter: Papillary dermal elastosis
Annie R Wang, Leslie Robinson-Bostom MD
Dermatology Online Journal 18 (8): 11

Department of Dermatology, Rhode Island Hospital
Warren Alpert Medical School of Brown University, Providence, Rhode Island

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Abstract

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).

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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).

In our paper, we described one case of a 33-year-old female patient with “1-2 mm white-to-yellow papules without surface change on the upper back and neck region” [1]. Histology was 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” [1]. We believe this histopathologically represented a unique elastic tissue disorder, which had not been previously described.

However, in the case published by Newlove et al, they clinically described “hyperpigmented atrophic patches” [2], which were inconsistent with the clinical features of our patient. Further, the histopathological description stated a “loss of elastic fibers throughout the papillary dermis and fragmentation of elastic fibers in the upper reticular dermis” [2]. Whereas this description was similar to our description of papillary dermal elastosis, there was no mention of clumped elastic tissue fibers alternating with areas exhibiting a lack of elastic tissue. Thus, this histologic appearance is more characteristic of PXE-PDE, which is defined by the lack of oxytalan and elaunin elastic fibers in the papillary dermis. Whereas PXE-PDE has been reported predominantly in women after the fifth decade of life, Lee et al reported a case in a 26-year-old female in 2002. Perhaps this case by Newlove et al could be the first documented case in a male patient.

We certainly appreciate this interesting case contribution by Newlove et al. However, based on our understanding, we do not think it is consistent with our observations of papillary dermal elastosis. We welcome your thoughts and comments.

References

1. Wang AR, Lewis K, Lewis M, Robinson-Bostom, L. Papillary dermal elastosis: a unique elastic tissue disorder or an unusual manifestation of pseudoxanthoma elasticum-like papillary dermal elastolysis? J Cutan Pathol. 2009 Sep;36(9):1010-3. Epub 2008 Dec 18. [PubMed]

2. Newlove T, Tzu J, Meehan S. Papillary dermal elastosis. Dermatology Online Journal. 2011 Oct;17(10):12. [PubMed]

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