Idiopathic middermal elastolysis

A 42-year-old white woman experienced widespread fine wrinkling and perifollicular protrusions in areas of erythematous patches with obvious photodistribution. Histological examination of the affected skin revealed loss of elastic tissue limited to the middermis. The clinical and histological presentation meets the criteria for the diagnosis of idiopathic middermal elastolysis. These findings support the previously postulated inflammatory pathogenesis for the loss of middermal elastic tissue and suggest that sun exposure may be a contributing factor. Idiopathic middermal elastolysis may represent only a variant in a spectrum of acquired wrinkling due to elastolysis with varying histological and clinical findings.