Elastose

Elastose, often referred to as elastosis, is a pathological change in connective tissue marked by abnormal behavior of elastic fibers. It most commonly affects the dermis of the skin, where the elastic fiber network becomes disorganized, fragmented, or excessively accumulated. The phenomenon can occur in other tissues that rely on elastic fibers, but it is most widely described in dermatology.

The most familiar form is solar elastosis (actinic elastosis), which results from long-term ultraviolet radiation exposure. In solar elastosis, the dermal elastic fibers become thickened, irregular, and basophilic, and the overall dermal matrix appears yellowish and wrinkled on clinical examination. Other forms include elastosis perforans serpiginosa, a condition characterized by transepidermal elimination of abnormal elastic fibers with grouped papules that often follow a serpiginous pattern, and senile elastosis, a term sometimes used to describe age-related changes in elastic tissue.

Pathophysiology involves damage to the dermal connective tissue by UV light, aging, and other environmental factors, leading to degradation and abnormal production of elastic fibers. Histologically, the arrangement of elastic fibers is disrupted, and special stains (such as orcein or Verhoeff-Van Gieson) highlight clumped or fragmented elastic tissue within a thickened dermis.

Clinically, solar elastosis presents as coarse, yellowish, wrinkled skin in sun-exposed areas, while elastosis variants may present with papules or plaques. Diagnosis is primarily clinical, supported by skin biopsy when needed.

Management focuses on reducing further damage and addressing symptoms: sun protection, topical retinoids, and, for certain lesions, laser therapy or chemical peels. Elastose itself is usually benign but signals accumulated sun damage and a higher risk of actinic skin changes.