506 Correspondence

Reply

To the Editor: We thank Drs. Trileb, Bruckner-Tuder­man, and Burg for their reportof a patient withthe EECsyndrome and scalp dermatitis. In our article we statedthat scalp dermatitis can be seen in patients with theRapp-Hodgkin,Bowen-Armstrong, andAECsyndromes.Thisstatement wasbasedonan analysisofcasesreportedin the literature. We also noted that patients with theABC syndrome were 6.6 timesmore likely to have scalpdermatitis than patients with the Rapp-Hodgkin syn­drome.With inclusionofthecasereportedbyTriiebetal.,patients with the AEC syndrome would also be morelikelyto havescalpdermatitisthan patients withthe EECsyndrome (7 of 12 vs 1 of 148).

Scott w: Fosko , MIJPKurt S. Stenn, MIY

Jean L. Bolognia, MYDepartment ofDermatology,

University ofPennsylvaniaSchool ofMedicine, Philadelphia"

Skin Biology Unit, R. W. Johnson PharmaceuticalResearch Institute, Raritan, New Jersey'

Department ofDermatology, Yale University Schoolof Medicine, New Haven, Connecticut"

The spectrum of dermal elastolysis

To the Editor: We haveread withgreat interest the clin­icalcasesofdermal elastolysis reportedbyBrodet al.1andby Betti et al.2 We recently reported a case of mid-der­mal elastolysis' and wewant to defineprecisely the clini­copathologicfeatures of the differentvarieties of elastol­ysis.

Mid-dermal elastolysis was first reported by Shelleyand Wood" as an acquired, noninflammatory disease inadults, witha pathognomonic histologic pattern: bandlikemid-dermal elastolysis without any other morphologiclesion.

The case of Betti et aP has the same clinical patternas type II mid-dermal elastolysis reported by Brenner etal.s with papular lesions and perifollicular protrusions.Histologically, elastic fibers were absent in the papillarydermis and focally in mid dermis, without a mid-dermalbandlike pattern . Instead of a clinical pattern similar tomid-dermal elastolysis, Betti et al. describedthe case asnoninflammatory dermal elastolysis.

We agree with them and postulate that there are twogroups of elastolysis. The first is represented by nonin­flammatoryelastolysis as in the caseof Betti et al. and thecases of typical mid-dermal elastolysis first reported byShelley and Wood4 and by other authors more recently.

The secondgroup is represented by postinf'lammatory

Journal of the American Academy of DermatologySeptember 1993

elastolysis. Some cases of postinfiammatory elastolysisare associated with cutis laxa6, 7; they were observed inchildren of African origin, except the one case of Lewiset a1.8 in a Caucasian girl.

Other postinflammatory elastolysis without cutis laxamay resemble mid-dermal elastolysis clinically, but thehistologic feature is the absenceof a bandlike pattern ofelastolysis in the mid dermis. Elastic fibers are absent inthe papillary and mid dermis and persistent elastic fibersare dystrophic;some inflammatory cells are present.

We believe that the caseof Brad et al. can be classifiedin this second group because the patient noticed inflam­matory lesions and because the histologic features werenot those of typical mid-dermal elastolysis.

Coincidentally, Shelley and Wood4 have reported apreceding inflammatory dermatosis in one case of mid­dermal elastolysis, and it is possible that the differencesbetweennoninflammatoryelastolysis and postinflamma­tory elastolysis are not so meaningful.

In addition, common features exist in all casesof elas­tolysis: a noninheriteddisease, female predominance, ab­sence of herniation clinically, and chronicity, withoutsystemic involvment.

M. Grossin"S. MaghraouiiB. Crickx" and

S. Belaich''Departments of Pathology" and Dermatology'

Hospital Bichat, 46, rue Henri Huchard75877 Paris Cedex 18, France

REFERENCES

I . Brod BA, Rabkin M, Rhodes AR, et aJ. Mid-dermalelastolysis with inflammation. J AM ACAD DERMATOL

1992;26:882-4.2. Betti R, Urbani CE, Lodi A, et al. Noninflammatory focal

dermal elastolysis. J AM ACAD DERMATOL 1992;27:113-5.3. Maghraoui S, Grossin M, Crickx B, et aJ.Mid dermal elas­

tolysis. J AM ACAD DERMATOL 1992;26:490-2.4. Shelley WB, Wood MG. Wrinkles due to idiopathic loss of

midderrna l elastic tissue. Br J Dermatol 1977;97:441-5.5. Brenner W, Gschnait F, Konrad K, et al. Noninflammatory

dermal elastolysis. Br J Dermatol 1978;99:335-8.6. Marshall J, Heyl T, Weber H . Post-inflammatory elastoly­

sis and cutis laxa. South Med J 1966;40:1016-22.7. Verhagen AR , Woerdeman MJ. Post-inflammatory elastol­

ysis and cutis laxa. Br J Derrnatol 1975;92:183-90.8. Lewis PG, Hood AF, Barnett NK, et al. Postinflammator y

elastolysis and cutis laxa. J AM ACAD DERMATOL1990;22:40-8.

Reply

To the Editor: I appreciate the interest in our reportshown by Grossin, Maghraoui, Crickx, and Belaich.It is