Journal of Postgraduate Medicine
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Year : 2019  |  Volume : 65  |  Issue : 1  |  Page : 60-61  

Linear focal elastosis localized to bilateral knee of a marathon runner

I Kaur1, D Jakhar1, SN Bhattacharya1, S Sharma2,  
1 Department of Dermatology and STD, University College of Medical Sciences and GTB Hospital (University of Delhi), New Delhi, India
2 Department of Pathology, University College of Medical Sciences and GTB Hospital (University of Delhi), New Delhi, India

Correspondence Address:
Dr. D Jakhar
Department of Dermatology and STD, University College of Medical Sciences and GTB Hospital (University of Delhi), New Delhi

How to cite this article:
Kaur I, Jakhar D, Bhattacharya S N, Sharma S. Linear focal elastosis localized to bilateral knee of a marathon runner.J Postgrad Med 2019;65:60-61

How to cite this URL:
Kaur I, Jakhar D, Bhattacharya S N, Sharma S. Linear focal elastosis localized to bilateral knee of a marathon runner. J Postgrad Med [serial online] 2019 [cited 2023 Sep 25 ];65:60-61
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A 16-year-old healthy girl presented with asymptomatic yellow bands around the bilateral knee since 3 years [Figure 1]a. The patient was a marathon runner and had been training for last 3 years. There was no history of rapid weight gain/loss, topical or systemic steroids, or hormonal therapy. The patient denied similar family history. On physical examination, multiple yellow raised linear and wavy bands were observed around both the knees. The bands were arranged in horizontal layers both above and below each knee. No similar lesions were observed over the back, upper limb, or intertriginous areas. Hematological, biochemical, and hormonal profile of the patient was within the normal limits. Dermoscopy showed linear and ill-defined yellow structureless areas without any vascular component [Figure 1]b. A punch biopsy was taken from the representative area and sent for histopathology. Hematoxylin and eosin stain showed normal epidermis with increased elastin fibers throughout the dermis [Figure 2]a. Verhoeff Van-Gieson stain showed the presence of increased thin, wavy elongated as well as fragmented elastin fibers [Figure 2]b. Based on clinical and histological findings, a diagnosis of linear focal elastosis was made. The patient was reassured and advised to avoid any vigorous training.{Figure 1}{Figure 2}

Linear focal elastosis (LFE) is characterized by linear, symmetric, palpable papules, and cords in a layered fashion on the mid-upper and lower back. Initial reports impressed upon its predisposition toward elderly males. However, recent studies have reported it in both males and females; and individuals as young as 7 years.[1] Although the most typical site of location is the back, LFE has also been reported on the face and extremities.[2] Reporting of familial cases have highlighted the possibility of genetic predisposition in this otherwise acquired disorder.[3] Its pathophysiology is still unclear. Temporal relationship of LFE with strenuous mechanical activities such as exercise has been reported earlier.[4] Mechanical forces and stretching can initiate a regenerative process in the elastin fibers. On histopathology, Chang et al. have observed a continuum of elastolysis in early stages with elastosis setting in later on.[1] This may indicate that the initial fragmentation of elastin fibers is followed by reactive regeneration. Linear configuration and orientation along Langer's lines further supports the mechanical force hypothesis. Growth spurt in younger individuals and UV exposure leading to actinic dermal elastosis are other possible factors leading to LFE. Both strenuous exercise and growth spurt might have been responsible for the development of LFE in the present case.

Histopathologically, abnormal wavy thin and fragmented elastin fibers with feathered ends can be demonstrated on special stains such as Verhoeff Van-Gieson and Orcein Giemsa. Immunofluorescence shows that markers of elastin are decreased or absent in the lesional skin.[5] Electron microscopy reveals elongated and/or fragmented, mature and immature microfibrils providing evidence for an active elastogenesis in the lesional skin.[2] Striae distensae, which is a common differential of LFE, on histology shows epidermal atrophy with loss of rete ridges, dermis shows edema, lymphocytic infiltrate and densely packed area of thin, eosinophilic, collagen bundles, horizontal to the surface in a parallel fashion.[6] There is an increase in the glycosaminoglycan content in striae. The number of vertical fibrillin fibers adjacent to the dermal-epidermal junction and the elastin fibers on the papillary dermis are significantly reduced.[6] Dermoscopy of striae distensae shows violaceous to the erythematous background with overlying linear vessels.

Avoidance of vigorous activity has been reported to halt the progression of lesions. Other treatment option includes centella asiatica extract.[2]

Declaration of patient consent

The authors certify that appropriate patient consent was obtained.

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1Chang SE, Park IJ, Moon KC, Koh JK. Two cases of linear focal elastosis (elastotic striae). J Dermatol 1998;25:395-9.
2Inaloz HS, Kirtak N, Karakok M, Ozgoztasi O. Facial linear focal elastosis: A case report. Int J Dermatol 2003;42:558-60.
3Moiin A, Hashimoto K. Linear focal elastosis in a young black man: A new presentation. J Am Acad Dermatol 1994;30:874-7.
4Florell AJ, Wada DA, Hawkes JE. Linear focal elastosis associated with exercise. JAAD Case Rep 2017;3:39-41.
5Akagi A, Tajima S, Kawada A, Ishibashi A. Coexistence of pseudoxanthoma elasticum-like papillary dermal elastolysis and linear focal dermal elastosis. J Am Acad Dermatol 2002;47:S189-92.
6Singh G, Kumar LP. Striae distensae. Indian J Dermatol Venereol Leprol 2005;71:370-2.

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