Linear Focal Elastosis: Diagnostic Criteria, Classification, and a Practical Approach Based on Seven Cases and a...

Linear focal elastosis (LFE) is a rare elastic tissue disorder characterized by palpable, yellowish, linear or band-like striae. We propose a practical clinicopathologic framework comprising a clinical classification, working diagnostic criteria, and a stepwise diagnostic algorithm to guide recognition, biopsy decisions, and management in routine practice. We categorize LFE into two clinical types: Classic truncal and atypical. As working diagnostic criteria, we suggest that a definitive diagnosis may be supported by at least two major criteria or one major and two minor criteria. The accompanying algorithm stratifies atypical or progressive presentations toward histopathologic confirmation. This framework is supported by a systematic review of 43 publications (88 patients) and an institutional series of 7 cases from two tertiary centers (total: 95 patients). Across both sources, male predominance, lower back involvement, and deep dermal elastosis were consistently observed. Most patients were asymptomatic and had stable outcomes with conservative management. By prioritizing structured diagnostic tools over descriptive case aggregation, this framework enables clinicians to confidently recognize LFE, avoid misdiagnosis, and prevent unnecessary interventions.