Solar elastosis

What is solar elastosis?

Solar elastosis, also known as actinic elastosis, is a disorder in which the skin appears yellow and thickened as a result of sun damage.

What does solar elastosis look like?

To the naked eye the skin appears yellow and thick, with bumps, wrinkles or furrowing.

How is solar elastosis diagnosed?

Solar elastosis is diagnosed clinically by its appearance or microscopically on skin biopsy. Histology shows loss of eosin staining on H&E sections resulting in a bluish colour of the upper dermis with accumulation of irregularly thickened elastic fibres. These elastic fibres degrade to form disorganised tropoelastin and fibrillin tangled structures.

The differential diagnosis of solar elastosis on the hands includes keratoelastoidalis marginalis, which is an acquired form of marginal keratoderma affecting the sides of the index fingers and thumbs. 

Who gets solar elastosis?

Solar elastosis affects people who have had long term sun exposure and is a feature of photoageing. It affects individuals of all skin types but its yellow hue is more obvious in white skinned individuals.

Smoking

Solar elastosis is also a manifestation of premature skin ageing caused by smoking.

Tobacco smoke affects the production of collagen and increases the production of tropoelastin and matrix metalloproteinases (MMP). These degrade matrix proteins and produce abnormal elastosis material in the dermis (1). The elastic fibre changes in smokers extend deep into the reticular dermis where as in sun damage these changes tend to be restricted to the more superficial papillary dermis. (2)

Prevention and treatment of solar elastosis

People with solar elastosis should minimise or avoid exposure to its known precipitants:

• careful sun protection measures with clothing and broad-spectrum high-protection sunscreens
• discontinue smoking and avoid exposure to passive smoking.

Ablative and non-ablative laser treatments, dermal fillers, and neurotoxin injections (botulinum toxin) have been used in attempt to improve the cosmetic appearance of solar elastosis.

It has been suggested that imiquimod may help to improve the histological appearance of sun damaged skin, including elastotic changes in the dermis, but this is unconfirmed (3).