Mid-dermal elastolysis in a patient undergoing chronic hemodialysis.

Mid-dermal elastolysis (MDE) is a rare acquired disorder of unknown etiology that typically presents as discrete patches of wrinkling over the trunk and arms or as perifollicular papules in the same distribution. The histopathologic finding of a bandlike loss of elastic tissue localized to the mid dermis is diagnostic. Our patient presented with atypical clinical features of urticarial papules and plaques that were histopathologically diagnostic of MDE. To our knowledge, the atypical presentation of MDE and association with hemodialysis have not been described. Furthermore, we believe matrix metalloproteinase (MMP) dysfunction to be involved in the pathogenesis of the disease.