Fibroelastolytic patterns of intrinsic skin aging: pseudoxanthoma-elasticum-like papillary dermal elastolysis and white fibrous papulosis of the neck.

BACKGROUND Cutaneous aging is due to intrinsic and extrinsic factors. While the pathologic hallmark of extrinsic aging (photoaging) is solar elastosis, intrinsic aging lacks any specific feature. Only a progressive thinning and loss of the dermal elastic network occasionally associated with focal thickening of the collagen bundles may be observed. In contrast to the different clinical patterns of solar elastosis, only one distinctive disorder has been related so far to intrinsic aging: the temporary wrinkles. OBJECTIVE Pseudoxanthoma-elasticum-like papillary dermal elastolysis (PDE) and white fibrous papulosis of the neck (WFP) are further clincopathologic patterns of intrinsic aging. MATERIAL AND METHODS Review of the literature and clinical and histologic studies of patients of our files. RESULTS PDE and WFP share some peculiar clinical and histologic features, namely their occurrence in late adulthood and thinning or loss of the elastic fibers, mainly in the papillary dermis. Moreover, elastolysis in PDE and focal fibrosis in WFP, along with the abnormal elastic fibers, immature elastogenesis and activation of fibroblasts observed in PDE, are quite similar to the changes described in intrinsic aging. CONCLUSIONS PDE and WFP along with temporary wrinkles and some cases of noninflammatory middermal elastolysis could be classified as 'age-related fibroelastolytic syndromes'.