Mid-dermal elastophagocytosis presenting as a persistent reticulate erythema

Two men are presented with a widespread persistent reticulate erythema concentrated within the chronically sun-damaged skin on their trunk. A fine papular element was present in one case and both lacked annular lesions. One patient was human immunodeficiency virus positive. Multiple skin biopsies showed an interstitial infiltrate of histiocytes containing multiple elastic fibres in the upper dermis. There was scant perivascular lymphocytic inflammation but no evident necrobiosis or palisaded granulomas seen typically with granuloma annulare. Elastic stains showed focal mid-dermal elastolysis. Diffuse reticulate erythema in sun-damaged skin may be a clinical marker for elastophagocytosis. This presentation differs from that previously described with actinic granuloma, diffuse granuloma annulare or the inflammatory phase of mid-dermal elastolysis and expands the clinical spectrum of this phenomenon.