Solar elastosis (syn. actinic elastosis)

Solar elastosis is the result of UV damage, and is characterised by yellow thickened skin with a cobblestone appearance, wrinkles, furrows, and sometimes comedones, affecting the head and neck.

This chapter is set out as follows:

• The cause is related to the cumulative lifetime exposure to UV radiation, and is more common in outdoor workers and in those living in sunny climates
• Tobacco smoking also increases the rate of premature skin ageing
• Severe elastosis may occur in photosensitive skin, for example in porphyria cutanea tarda

• It does not usually present until the fourth decade or later but cumulative UV exposure is more important than chronological age alone
• Fair‐skinned people are the worst affected, although the condition can occur in people with darker skin

Distribution

• The UV‐exposed areas are affected, especially the forehead, bald scalp and the back of the neck

Morphology

• Yellow discolouration
• Diffuse skin thickening
• A cobblestone appearance
• Wrinkles
• Furrows - the skin of the neck may be divided by well‐defined furrows into an irregular rhomboidal pattern
• Comedones - most commonly seen in periorbital skin and is usually symmetrical, but unilateral and circumscribed forms can occur

• The main aspect of management is to reduce the rate of further premature skin aging by UV-protection and stopping smoking

• Several treatments can improve the appearance of the skin, but are only provided privately, these include - topical retinoids, laser, dermal fillers, and botulinum toxin injections