Unilateral Dermatoheliosis

Abstract

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. Histopathologi- cal 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 FavreRacouchot 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 stra- tum 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 monitor- ICM REG F CASE EMail AUTHOR FIGURE TITLE Gordon fig1 Line Enon ARTIST: mleahy FILL H/T Combo 4-C H/T AUTHOR, PLEASE NOTE: Figure has been redrawn and type has been reset. Please check carefully. JOB: 36616 ISSUE: 4-19-12 RETAKE Revised SIZE 198pts 1st 2nd 3rd ing for skin cancer were recommended for the patient.