Images in Clinical Medicine

Unilateral Dermatoheliosis

Jennifer R.S. Gordon, M.D., and Joaquin C. Brieva, M.D.

N Engl J Med 2012; 366:e25April 19, 2012DOI: 10.1056/NEJMicm1104059

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A 69-year-old man presented with a 25-year history of gradual, asymptomatic thickening and wrinkling of the skin on the left side of his face. The physical examination showed hyperkeratosis with accentuated ridging, multiple open comedones, and areas of nodular elastosis. Histopathological analysis showed an accumulation of elastolytic material in the dermis and the formation of milia within the vellus hair follicles. Findings were consistent with the Favre–Racouchot syndrome of photodamaged skin, known as dermatoheliosis. The patient reported that he had driven a delivery truck for 28 years. Ultraviolet A (UVA) rays transmit through window glass, penetrating the epidermis and upper layers of dermis. Chronic UVA exposure can result in thickening of the epidermis and stratum corneum, as well as destruction of elastic fibers. This photoaging effect of UVA is contrasted with photocarcinogenesis. Although exposure to ultraviolet B (UVB) rays is linked to a higher rate of photocarcinogenesis, UVA has also been shown to induce substantial DNA mutations and direct toxicity, leading to the formation of skin cancer. The use of sun protection and topical retinoids and periodic monitoring for skin cancer were recommended for the patient.

Jennifer R.S. Gordon, M.D.
Joaquin C. Brieva, M.D.
Northwestern University, Chicago, IL
jrsgordon@gmail.com

Citing Articles (9)

Citing Articles

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   A.Mavon. (2015) Acetyl aspartic acid, a novel active ingredient, demonstrates potential to improve signs of skin ageing: from consumer need to clinical proof. International Journal of Cosmetic Science 37:10.1111/ics.2015.37.issue-S1, 1-2
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   Mariëtte E. C.Waaijer, David A.Gunn, Peter D.Adams, Jeff S.Pawlikowski, Christopher E. M.Griffiths, Dianavan Heemst, P. ElineSlagboom, Rudi G. J.Westendorp, Andrea B.Maier. (2015) P16INK4a Positive Cells in Human Skin Are Indicative of Local Elastic Fiber Morphology, Facial Wrinkling, and Perceived Age. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, glv114
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   N.Kluger. (2015) Dermatoses associées à la conduite automobile. Annales de Dermatologie et de Vénéréologie 142, 287-291
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   AnneHan, Anna L.Chien, SewonKang. (2014) Photoaging. Dermatologic Clinics 32, 291-299
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   Steven Q.Wang, Paul R.Tanner, Henry W.Lim, J. F.Nash. (2013) The evolution of sunscreen products in the United States – a 12-year cross sectional study. Photochemical & Photobiological Sciences 12, 197
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   WannitTongkao-on, ClareGordon-Thomson, Katie M.Dixon, Eric J.Song, TanLuu, Sally E.Carter, Vanessa B.Sequeira, Vivienne E.Reeve, Rebecca S.Mason. (2013) Novel vitamin D compounds and skin cancer prevention. Dermato-Endocrinology 5, 20-33
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   Steven Q.Wang, Paul R.Tanner, Henry W.Lim, J. F.Nash. (2013) The evolution of sunscreen products in the United States – a 12-year cross sectional study. Photochem. Photobiol. Sci. 12, 197-202
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   HermannFüeßl. (2012) Dermatoheliosis — einseitig gealtert. hautnah dermatologie 28, 210-210
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   H. S.Füessl. (2012) Einseitig gealtert. MMW - Fortschritte der Medizin 154, 38-38
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