Solar elastosis

What is solar elastosis?

Solar elastosis is a disorder in which the skin appears yellow and thickened as a result of abnormal elastic tissue accumulation, due to chronic sun damage on ageing skin. Solar elastosis is also known as actinic elastosis and elastosis senilis.

Solar elastosis 

Solar elastosis 

Severe solar wrinkling and a basal cell carcinoma 

Yellow lesions of solar elastosis on the nose 

Solar elastosis on the upper lip mimicing lemon skin 

Favre-Racouchot syndrome showing elastosis and solar comedones and cysts 

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Who gets solar elastosis?

Solar elastosis is a feature of photo-ageing. It affects males and females of all skin types who have had long-term sun exposure. Although it does not usually present until the fourth decade, cumulative ultraviolet (UV) radiation exposure is the most important risk factor.

What causes solar elastosis?

Ultraviolet radiation

• Prolonged ultraviolet (UV) exposure, for example through natural sunlight or artificial sunbed exposure, is the primary aetiological factor for developing solar elastosis.
• UV radiation breaks down collagen and elastin fibres in connective tissue within the dermis, causing the skin to lose its elastic qualities.
• Abnormal elastic tissue accumulates to overcompensate for this damage, leading to elastosis.

Smoking

• Tobacco smoke increases the rate of premature skin ageing by encouraging the production of degradative enzymes such as matrix metalloproteinases (MMP) and tropoelastin that cause disorderly elastin deposition in the skin.
• Elastic fibre changes in smokers extend deeper into the reticular dermis, whereas sun damage is more restricted to the superficial papillary dermis.

See also: Smoking and its effects on the skin.

Photosensitive skin

• Conditions contributing to increased photosensitivity, such as porphyria cutanea tarda or immunosuppression, lead to a higher risk of developing solar elastosis.
• People with lighter skin types are also more prone to the effects of sun damage.

What are the clinical features of solar elastosis?

• Solar elastosis mainly affects sun-exposed sites of skin such as the face, ears, neck, forearms, and hands.
• The skin appears dry, thick, and yellow, with bumps, wrinkles, or furrowing. It may resemble lemon skin and the yellow gemstone citrine (called Milian citrine skin).
• Comedones or a cobblestoned appearance may also be seen.
• Due to sun damage, areas of increased or uneven pigmentation and keratosis may occur.

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How do clinical features vary in differing types of skin?

Although solar elastosis affects individuals of all skin types, its yellow hue is more noticeable in people with fairer skin. Those with fairer Fitzpatrick skin phototypes are also more susceptible to effects of sun damage and developing solar elastosis. One study noted an inverse relationship between degree of solar elastosis and degree of melanin pigmentation in the skin.

What are the complications of solar elastosis?

Chronic and prolonged exposure to ultraviolet (UV) radiation damages DNA and is a major contributor to development of skin cancer. Therefore, individuals with solar elastosis due to photodamage are also more likely to have other conditions associated with accumulated sun exposure such as:

• Melanoma
• Non-melanoma skin cancers (eg, cutaneous squamous cell carcinoma or basal cell carcinoma)
• Actinic keratosis.

How is solar elastosis diagnosed?

Solar elastosis is diagnosed mainly from clinical appearance, and can be confirmed microscopically with skin biopsy.

• Early histological changes show irregularly-thickened elastic fibre accumulation in the upper dermis.
• As the condition progresses, the fibres form coarse, disorganised, and tangled structures.
• The degree of elastosis correlates with the relative exposure to UV radiation.

What is the differential diagnosis for solar elastosis?

• Pseudoxanthoma elasticum
• Favre-Racouchot syndrome (nodular elastosis)
• Linear focal elastosis
• Elastoma (a type of connective tissue naevus)
• Buschke-Ollendorff syndrome
• Keratoelastoidosis marginalis (degenerative collagenous plaques)

What is the treatment for solar elastosis?

As solar elastosis is mainly caused by prolonged UV radiation, the main aspect of treatment is to prevent further photodamage and premature skin ageing through sun protection and smoking cessation.

Other treatment options to improve the cosmetic appearance of elastotic skin include:

• Intense pulsed light therapy
• Laser resurfacing
• Chemical peels
• Dermal fillers
• Botulinum toxin (Botox) injections
• Topical treatments such as retinoids, imiquimod, tacrolimus, and oestrogen – although these have variable efficacy reported.

How do you prevent solar elastosis?

People with solar elastosis should minimise or avoid exposure to known precipitants.

• Sun protective measures with broad-spectrum high SPF (sun protection factor) sunscreen, minimising sun exposure especially during peak UV radiation hours, and wearing sun protective clothing and a wide-brim hat.
• Smoking cessation (and avoiding exposure to passive / second-hand smoking).
• Several studies have suggested that a healthy diet with a higher intake of vegetables may reduce actinic skin damage and facial wrinkling.

What is the outcome for solar elastosis?

There are several cosmetic treatment options available for solar elastosis.

As it is often caused by cumulative chronic exposure to solar ultraviolet (UV) radiation, there is an association with other conditions linked to sun damage, such as skin cancer. Regular skin checks are important, as well as prompt review of any new or changing skin lesions and sun protection to minimise further skin photodamage.

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