Actinic, or solar, elastosis is an accumulation of abnormal elastin

Elastin

Elastin is a protein in connective tissue that is elastic and allows many tissues in the body to resume their shape after stretching or contracting. Elastin helps skin to return to its original position when it is poked or pinched. Elastin is also an important load-bearing tissue in the bodies of...

 (elastic tissue) in the dermis

Dermis

The dermis is a layer of skin between the epidermis and subcutaneous tissues, and is composed of two layers, the papillary and reticular dermis...

 of the skin

Skin

-Dermis:The dermis is the layer of skin beneath the epidermis that consists of connective tissue and cushions the body from stress and strain. The dermis is tightly connected to the epidermis by a basement membrane. It also harbors many Mechanoreceptors that provide the sense of touch and heat...

, and in the conjunctiva

Conjunctiva

The conjunctiva covers the sclera and lines the inside of the eyelids. It is composed of rare stratified columnar epithelium.-Function:...

 of the eye

Human eye

The human eye is an organ which reacts to light for several purposes. As a conscious sense organ, the eye allows vision. Rod and cone cells in the retina allow conscious light perception and vision including color differentiation and the perception of depth...

, which occurs as a result of the cumulative effects of prolonged and excessive sun exposure, a process known as photoaging.

Clinical features

Actinic elastosis usually appears as thickened, dry, wrinkled skin. Several clinical variants have been recorded. One of the most readily identifiable is the thickened, deeply fissured skin seen on the back of the chronically sun-exposed neck, known as cutis rhomboidalis nuchae

Cutis rhomboidalis nuchae

Cutis rhomboidalis nuchae is a cutaneous condition of the posterior neck, characterized by deep furrowing of the skin....

. These features are a part of the constellation of changes that are seen in photoaged skin.

Causes / Aetiology

The origin of the elastotic material in the dermis remains a subject of debate. Theories on the formation of the elastotic material include actinic stimulation of fibroblast

Fibroblast

A fibroblast is a type of cell that synthesizes the extracellular matrix and collagen, the structural framework for animal tissues, and plays a critical role in wound healing...

s, promoting synthesis of this material; or that the material is a degradation product of collagen

Collagen

Collagen is a group of naturally occurring proteins found in animals, especially in the flesh and connective tissues of mammals. It is the main component of connective tissue, and is the most abundant protein in mammals, making up about 25% to 35% of the whole-body protein content...

, elastin

Elastin

Elastin is a protein in connective tissue that is elastic and allows many tissues in the body to resume their shape after stretching or contracting. Elastin helps skin to return to its original position when it is poked or pinched. Elastin is also an important load-bearing tissue in the bodies of...

 or both.

Histopathology

In the earlier stages of actinic elastosis, elastic fiber proliferation can be seen in the dermis. As the condition becomes more established, the collagen fibers of the papillary dermis and reticular dermis

Reticular dermis

The reticular dermis is the lower layer of the dermis, found under the papillary dermis, composed of dense irregular connective tissue featuring densely packed collagen fibers. It is the primary location of dermal elastic fibers....

 become increasingly replaced by thickened and curled fibers that form tangled masses and appear basophilic

Basophilic

Basophilic is a technical term used by histologists. It describes the microscopic appearance of cells and tissues, as seen down the microscope, after a histological section has been stained with a basic dye. The most common such dye is haematoxylin....

 under routine haematoxylin

Haematoxylin

Haematoxylin, hematoxylin, Natural Black 1, or C.I. 75290 is extracted from the heartwood of the logwood tree. When oxidized it forms haematein, a compound that forms strongly coloured complexes with certain metal ions, the most notable ones being Fe and Al salts. Metal-haematein complexes are used...

 and eosin

Eosin

Eosin is a fluorescent red dye resulting from the action of bromine on fluorescein. It can be used to stain cytoplasm, collagen and muscle fibers for examination under the microscope. Structures that stain readily with eosin are termed eosinophilic....

 staining. These fibers stain black with the Verhoeff stain.

Treatment

There are numerous treatment options for photoaged skin. These include dermabrasion

Dermabrasion

Dermabrasion is a surgical procedure that involves the controlled abrasion of the upper layers of the skin with sandpaper or other mechanical means. Nowadays it has become common to use CO2 or Erbium:YAG laser as well. The procedure requires a local anaesthetic...

, topical application of retinoic acid

Retinoic acid

Retinoic acid is a metabolite of vitamin A that mediates the functions of vitamin A required for growth and development. Retinoic acid is required in chordate animals which includes all higher animals from fishes to humans...

, carbon dioxide laser

Carbon dioxide laser

The carbon dioxide laser was one of the earliest gas lasers to be developed , and is still one of the most useful. Carbon dioxide lasers are the highest-power continuous wave lasers that are currently available...

 resurfacing, hyaluronic acid injection into the dermis, Imiquimod

Imiquimod

Imiquimod is a prescription medication that acts as an immune response modifier. It is marketed by Meda AB, Graceway Pharmaceuticals and iNova Pharmaceuticals under the trade names Aldara and Zyclara, and by Mochida as Beselna. It is also referred to as R-837.- History :The original FDA approval...

, tacrolimus

Tacrolimus

Tacrolimus is an immunosuppressive drug that is mainly used after allogeneic organ transplant to reduce the activity of the patient's immune system and so lower the risk of organ rejection...

 ointment and topical oestrogen therapy. These treatments have variable efficacy

Efficacy

Efficacy is the capacity to produce an effect. It has different specific meanings in different fields. In medicine, it is the ability of an intervention or drug to reproduce a desired effect in expert hands and under ideal circumstances.- Healthcare :...

.

The most effective prevention strategy for photoaging remains minimization of sun-exposure through use of sunscreen and other sun exposure avoidance measures.

See also

• Link to DermIS.net webpage with picture of solar elastosis http://dermis.multimedica.de/dermisroot/en/29096/image.htm
• List of cutaneous conditions