Case Number : Case 2122 - 27 July 2018 Posted By: Dr. Richard Carr

Clinical picture is of hypothyroidism. Histology supports it by showing mild hyperkeratosis, follicular plugging ( reflection of xerosis) and mucin in the dermis.

Looks like there is patchy loss of elastic fibers. Elastic stain? 

Some extra images added for a further clue.

Admin

Mid Dermal Elastolysis-MDE

Thickened, coarse elastic fibres and solar elastosis at the typical site - Favre-Racouchot syndrome.

Agree with FRS. 

2 hours ago, Anil Patki said:

Thickened, coarse elastic fibres and solar elastosis at the typical site - Favre-Racouchot syndrome.

Agree. Multiple comedones also. 

Mid dermal elastolysis is unusual on the face. However, I think the EVG stain supports this diagnosis.  There is only one comedone.  The clinical picture is suggestive of comedones but not sure.  I look forward to the answer!

I have to say that my first impression was FRS, but not sure about it

Thanks. Based on CPC I favoured acquired & localised cutis laxa (loss of elastic in the mid/upper dermis). Think FRS is a reasonable suggestion although the anatomic location would be odd (including swelling of the outer brow).