Actinic elastosis L57.4

Skin change occurring in sun-exposed areas of older people, predominantly with light complexion, characterised by increased wrinkling and irregular pigmentation (see below Lentigo solaris). A coarse follicular structure (with possible keration retentions) and a shiny, whitish protruding interfollicular skin is usually noticeable.

Increased wrinkle formation, partly with rhomboid skin fields and irregular pigmentation. In advanced stages of the disease, the skin is cloggy with black follicular horn retentions, possibly paired with hypertrichosis (see below elastoidosis cutanea nodularis et cystica). Frequently combination damage in aged skin (photoaging + intrinsic chronological aging).

The target cells of chronic light damage are melanocytes, keratinocytes and fibroblasts. In pronounced actinic elastosis, a cloddy basophilic degeneration of the elastic fibre systems(elastin) is found under an atrophic epidermis. This initially affects the upper and adjacent middle dermis. Instead of a structured texture of the elastic fibres, depending on the degree of damage, there are either thickened, irregularly interwoven fibre bundles which stain like elastic material. In advanced stages, only amorphous, basophilic conglomerates are found in the upper, middle and deep dermis.

Prevention: Textile and physical/chemical light protection (e.g. Anthelios®).

Active therapy:

• Successes with creams containing vitamin A acids (e.g. Cordes VAS cream; Tazarotene 0.1%) or glycolic acid-containing topicals (e.g. Neostrata, Neotop, Avène) have been described.
• Skin care with greasy external agents like e.g. ash base cream, linola milk, linola fat cream, excipial almond oil ointment.
• Caution: Attention should be paid to the occurrence of melanocytic or non-melanocytic malignancies.

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2. Calderone DC et al (1995) The clinical spectrum of actinic elastosis. J Am Acad Dermatol 32: 1016-1024
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4. Edwards C et al (2003) A study of differences in surface roughness between sun-exposed and unexposed skin with age. Photodermatol Photoimmunol Photomed 19: 169-174
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6. Kang S et al (2004) A multicenter, randomized, double-blind trial of tazarotene 0.1% cream in the treatment of photodamage. J Am Acad Dermatol 52: 268-274
7. Ohnishi Y et al (2000) Expression of elastin-related proteins and matrix metalloproteinases in actinic elastosis of sun-damaged skin. Arch Dermatol Res 292: 27-31
8. Tanaka N et al (2001) Immunohistochemical detection of lipid peroxidation products, protein-bound acrolein and 4-hydroxynonenal protein adducts, in actinic elastosis of photodamaged skin. Arch Dermatol Res 293: 363-367