Lax skin pathology

Skin lax is characterized by the fragmentation of cutaneous elastic fibers, giving rise to loose and sagging skin that can give the appearance of premature aging. Inheritable and acquired forms are described. In some cases extracutaneous Sites including the lung and gastrointestinal tract are involved.

Histology loose skin

In loose skin, dermal the elastic fibers are altered and reduced in number; however, these changes can be difficult to appreciate on hematoxylin and eosin staining. The remaining fibers are shortened and may have a hazy appearance. Giant cells which wraps fragments of elastic fiber and a slight perivascular lymphocytic infiltrate can be seen (Figure 1).

Special studies of lax skin

Electron microscopy confirms the irregular fragmentation of the elastic fiber structure. Changes to collagen Fibers have been reported, although it is believed to be a minor change due to altered skin mechanics.

Staining with acidic orcein reveals reduction or absence of elastic fibers in the dermis (Figures 1–4). The elastic fibers are stained black with acidic orceline (Figure 1, arrow).

Differential diagnosis loose skin

Anetoderma: early lesions may show perivascular or periadnexal mononuclear inflammatory infiltrate in addition to fragmentation and loss of elastic fibers. Changes are more focal that diffuse elastolysis seen in loose skin, however, this is difficult to appreciate in a small biopsy.

Middle dermal elastolysis: Changes are limited to the middle dermis with early lesions demonstrating perivascular lesions and interstitial inflammatory infiltrate with reduction or absence of elastic fibers. Subsequent lesions show thickening of dermal collagen, an unusual feature for cutis laxa.

Perifolicular elastolysis: elastolysis focused exclusively on hair follicles.

Pseudoxanthoma elastic papillary dermal elastolysis: mainly affects papillary dermis, although less elastolysis and distortion of elastic fibers in the lattice dermis Has been reported. Flattening of the epidermis It is an additional feature.

The above conditions may be easier differentiated of lax skin for clinical reasons.