Dermatoheliosis

From Anvita Health Wiki

Contents 1 Introduction 2 Etiology 3 Epidemiology 4 Pathology 5 Genetics 6 Clinical-manifestations 7 Complications 8 Management 9 More General Terms 10 Additional Terms 11 References

Introduction

• Polymorphic response of epidermal cells, dermal connective tissue & vascular system to prolonged &/or excessive exposure to ultraviolet radiation.

Etiology

• ultraviolet B (290-320 nm) is most potent offender
• ultraviolet A (320-400 nm) can induce the same pathology

Epidemiology

• whites
• most often in individuals > 40 years of age
• higher incidence in males
• people living in high altitudes & low latitudes
• individuals with outside occupation
• individuals with inability to tan

Pathology

• epidermis

• acanthosis of the epidermis
• increased horny layer
• flattening of the dermal-epidermal junction
• atypia of keratinocytes

• dermis

• loss of small vessels in the papillary dermis
• elastosis
• an increase in fibroblasts
• decrease in collagen

• decreased synthesis (specifically procollagen 1)
• increased collagenase activity

• increase in elastin

• severity depends upon the duration & intensity of sun exposure & facultative melanin pigmentation beginning with 1st exposures early in life

Genetics

• variations in MC1R influence severity of photoaging [2]

Clinical-manifestations

• patient appears wrinkled, looks older than chronologic age

• coarse furrows
• fine wrinkles

• irregular pigmentation
• actinic keratosis
• solar lentigo
• telangiectasias, purpura, easy bruising
• venous lakes
• yellow dermal papules & plaques
• loss of skin elasticity

• pebbly texture of skin ( elastosis)

• comedones (especially periorbital)
• distribution: sun-exposed areas

Complications

• skin cancer
• actinic purpura

Management

• dermatoheliosis is generally progressive & irreversible

• may continue even after sun-exposure is restricted
• spontaneous reversal has been observed

• Pharmacologic agents

• topical tretinoin
• topical 5-fluorouracil may cause disappearance of actinic keratosis
• methyl aminolevulinate ( MAL) plus red light [2]

• MAL is incubated for 3 hours under occlusion before an 8- minute red-light irradiation
• treatments 3 weeks apart
• associated with considerable pain
• strictly avoid bright light for 1 or 2 days

• prevention

• sunscreen
• protective clothing

More General Terms

• skin disease (dermatologic disorder, dermatopathy, dermatosis)

Additional Terms

• actinic (solar) keratosis (AK)
• basal cell carcinoma (BCC)
• elastosis
• melanoma
• poikiloderma of Civatte
• skin aging (includes aging of skin appendages)
• solar (senile) lentigo

References

1. Color Atlas & Synopsis of Clinical Dermatology, Common & Serious Diseases, 3rd ed, Fitzpatrick et al, McGraw Hill, NY, 1997, pg 232-35
2. Elfakir A et al. Functional MC1R-gene variants are associated with increased risk for severe photoaging in facial skin. J Invest Dermatol 2010 Apr; 130:1107. PMID: [1]
3. Sanclemente G et al. A prospective split-face double-blind randomized placebo- controlled trial to assess the efficacy of methyl aminolevulinate + red-light in patients with facial photodamage. J Eur Acad Dermatol Venereol 2011 Jan; 25:49 PMID: [2]
4. Sunlight, Ultraviolet Radiation, and the Skin [3]

dermatoheliosis (photoaging, skin aging)