Authors: Dr Amanda Oakley, Dermatologist, Waikato Hospital, New Zealand (1999); review and minor update by Dr James A. Ida, MD, Dermatologist, Veterans Administration, USA (2024)
A solar or senile comedo (plural comedones) is a small skin-coloured papule found on the face of middle-aged or older individuals. Solar comedones tend to affect actinically damaged areas that have been exposed to sunlight over long periods of time.
The comedones may be open (‘blackheads’) or closed (‘whiteheads’) and are usually not inflamed.
Solar comedones are not related to comedones found in acne vulgaris.
Solar comedones
Solar comedones, mostly of the closed type
Solar comedones of the open type: the upper cheek is a typical site
Favre-Racouchot syndrome
Solar comedones and larger pseudocysts occur in association with solar elastosis, which causes yellowish, leathery skin and deep furrows. This combination of findings is also known as Favre-Racouchot syndrome and tends to affect the skin around the eyes, the temples, and the lateral neck. Favre-Racouchot syndrome is thought to be due to a combination of sun exposure and heavy smoking.
Deep linear furrows on the posterior neck due to solar elastosis, called cutis rhomboidalis nuchae, may also accompany Favré-Racouchot.
Cutis rhomboidalis nuchae often seen in association with Favre Racouchot syndrome
Solar comedones on the nose
Solar comedones
Solar comedones
Favré-Racouchot syndrome
Image from Dr S Janjua
Image from Dr S Janjua
Management of solar comedones
Use sun protection and frequently re-apply a broad-spectrum sunscreen with a sun protection factor (SPF) of 30 or higher to exposed skin.
Wash affected areas twice daily with mild soap or cleansers and water.
Apply retinoid cream to affected areas at night (this requires a doctor's prescription).
Apply light moisturisers if the skin is dry (dryness may be aggravated by the retinoid).
The contents of the comedones can be gently squeezed out using a ‘comedo expressor’ (an instrument that can be purchased online or at a local pharmacy).
Comedones may also be removed by electrocautery or laserablation. However, they may recur and require further treatment from time to time.
Bibliography
Paganelli A, Mandel VD, Kaleci S, et al. Favre-Racouchot disease: systematic review and possible therapeutic strategies. J Eur Acad Dermatol Venereol. 2019;33(1):32–41. doi: 10.1111/jdv.15184. Journal
Sobjanek M, Sławińska M, Biernat W. A case of unilateral inflamed plaques with comedones on the face: another case of an uncommon clinical presentation of Favre-Racouchot disease. Dermatol Pract Concept. 2019;9(4): 308–309. doi: 10.5826/dpc.0904a15. Article
Sonthalia S, Arora R, Chhabra N, Khopkar U. Favre-Racouchot syndrome. Indian Dermatol Online J. 2014;5(Suppl 2):S128–9. doi: 10.4103/2229-5178.146192. Article
