Idiopathic Localized Acquired Cutis Laxa in an Adult Male: A Case Report

Cutis laxa (CL) is a rare connective-tissue disorder characterized by loose, inelastic skin due to defects in elastic fiber production or structure. Acquired cutis laxa (ACL) typically develops in adulthood and may follow inflammatory or immune-mediated events, though idiopathic cases remain uncommon. We report a 29-year-old male with a 10-year history of progressive skin laxity affecting the face, neck, and upper back. There were no preceding infections, drug exposures, or inflammatory skin conditions. Medical, surgical, and family histories were unremarkable. Examination revealed redundant, wrinkled skin with markedly reduced recoil in the involved areas, without joint hypermobility or systemic features suggestive of connective-tissue disease. Laboratory tests and imaging were normal. Histopathology demonstrated diminished and fragmented elastic fibers throughout the dermis, confirmed by Verhoeff-Van Gieson staining, consistent with ACL. This case represents an idiopathic, localized adult-onset form of ACL. The characteristic histological findings, along with the absence of systemic involvement, support the diagnosis. It is important to distinguish this condition from others, such as Ehlers-Danlos syndrome, anetoderma, and pseudoxanthoma elasticum, since overlapping clinical features can lead to misdiagnosis. Idiopathic ACL is rare and often under-recognized, and this case represents the first reported regional idiopathic instance, to the best of our knowledge, from Saudi Arabia. Overall, this case highlights the value of careful clinical assessment and histological evaluation in patients with slowly progressive, non-inflammatory skin laxity.