Nonmalignant Photodamage

Joseph F. Coffey, BSc, MD; Gordon E. Searles, OD, MD, MSc, FRCPC

Disclosures

Geriatrics and Aging. 2006;9(7):494-498. 

In This Article

Abstract and Introduction

As the population ages, the corresponding rise in incidence of skin cancer and photodamaged skin necessitate skin assessments of older patients in the dermatology clinic. Sallowness, wrinkles, solar lentigos, and other benign conditions reflect extensive ultraviolet damage to the skin, and provide a background of mutagenesis for skin cancer formation. Some treatments available for photodamaged skin are cosmetic and only available in a dermatology or plastic surgery office setting. However, there are many treatments that improve sun-damaged skin as well as prevent progression to skin cancer formation; these tools are available in the primary care physician's office. This article addresses ablative and nonablative treatment options for sun-damaged skin and encourages the promotion of sun-safe behaviours, including use of protective clothing and sunscreen.

Types of Nonmalignant Photodamage. Damage to epidermal structures results in several nonmalignant skin conditions. Solar lentigos (liver spots) in sun-exposed areas may grow in size, change colour with sun exposure, and are commonly mistaken for melanoma. Ephelides (freckles) may also occur due to excess sun accumulation but result in an excess of melanin, not melanocytes, and may fade with lack of sun stimulus. Photo-damaged skin also shows dyschromia, with hyper- and hypopigmentation on the cheeks, face, V-neck region, and forearms of older individuals.

Ultraviolet damage to dermal structures may result in a condition known as poikiloderma of Civatte (Figure 1). This represents a zone of erythema, telangiectasia, mottled brown pigment, and cutaneous atrophy in sun-exposed areas, especially on the V-neck area. Solar purpura presents as red-blue macules and patches on the arms and hands resulting from shearing forces on fragile skin (Figure 2). Wrinkles (rhytides) develop secondary to damaged dermal fibroblasts with altered collagen and elastin production. This promotes loss of skin turgor, loss of elastic recoil, increased skin folds, leathery skin, yellow/sallow colour, and cobblestoning of the upper lip.

Poikiloderma of Civatte

Solar Purpura

Solar elastosis, or photodamaged elastin, causes multiple benign clinical skin lesions including loss of elasticity, thick neck creases (cutis rhomboidalis nuchae [Figure 3]), solar elastic bands on the forearms, actinic comedonal papules (Figures 4 and 5), cysts and comedones, elastolytic nodules on the helix of the ear, actinic granulomas, chondrodermatitis nodularis helicis, and cherry angiomas.

Cutis Rhomboidalis

Actinic Keratosis I

Actinic Keratosis II

Subcutis features of sun damage include sagging of skin due to atrophy of musculature, fat, and fascia. This characteristically presents as the sagging skin of the anterior neck in many older patients.[1]

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