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Immunohistochemical Investigation of Mid-Dermal Elastolysis With a History of Erythema

Suda, Takane MD*; Hara, H MD*; Yoshitake, M MD*; Ohbayashi, T MD; Nakamura, T MD; Terui, T MD*

The American Journal of Dermatopathology: October 2008 - Volume 30 - Issue 5 - p 477-480
doi: 10.1097/DAD.0b013e318176b874
Extraordinary Case Report

Elastic fibers are essential extracellular matrix macromolecules comprising an elastin core surrounded by fibrillin-rich microfibrils. Fibulin-5, a microfibril, has been identified as one of the secreted extracellular matrix proteins that shows function as a scaffold for elastic fibers. However, the distribution of fibulin-5 in the skin is not clear. We report a case of a 43-year-old woman with erythema and subsequent wrinkling that met the clinical and histological criteria for mid-dermal elastolysis. We investigate the mechanism by which this disease occurs. The distribution of elastin, CD68, matrix metalloproteinase (MMP)-9, and fibulin-5 was examined immunohistochemically from both erythematous and wrinkled skin. There were numerous CD68+ and MMP-9-producing histiocytes and giant cells in the erythematous lesions. Faint fibrillar staining of fibulin-5 was found in the deep dermis. In the wrinkled skin, there were few CD68+ histiocytes or giant cells. Elastin immunoreactivity disappeared from the mid-dermis. Fibulin-5 colocalized in the lower dermis, shorter than in the erythema. Mid-dermal elastolysis may be initiated by MMP-9 produced by histiocytes and giant cells through its degradation of elastic fibers. In the lower dermis of the wrinkled skin, the fragmented expression of fibulin-5 was associated with the incomplete reproduction of the elastic fibers.

From the *Department of Dermatology, Nihon University School of Medicine, Tokyo, Japan; and †Horizontal Medical Research Organization, Kyoto University School of Medicine, Kyoto, Japan.

Reprints: Takane Suda, MD, Department of Dermatology, Nihon University School of Medicine, 30-1 Oyaguchi-kamimachi Itabashi-ku, Tokyo 173-8610, Japan (e-mail:

© 2008 Lippincott Williams & Wilkins, Inc.