Bullous solar elastosis

Abstract

Solar elastosis (SE) is a well-recognized manifestation of chronic sun exposure, mainly affecting white patients. Well-established clinical manifestations of SE include Favre-Racouchot syndrome, cutis rhomboidalis nuchae, actinic comedonal plaques, elastomas, elastotic nodules of the ears, elastotic bands, collagenous plaques of the hands and colloid millia. Bullous SE is a very unusual presentation of SE, which consists clinically of tense bullae on chronically sun-damaged skin and is characterized histopathologically by a dermal cleft within a dermis with severe SE. Bullous SE is a rare but characteristic clinical expression of SE.

Bullous solar elastosis: an exceedingly rare clinical presentation of actinic elastosis

“…Some authors proposed that these changes most probably result from shearing trauma in severely sun‐damaged skin based on the presence of both extravasated red blood cells and an inflammatory infiltrate mainly composed of neutrophils and the fact that the clefts were well defined by fibrin 10 . However, in others reports, including our patient, there was no fibrin deposition lining the cleft, and the sparse inflammatory infiltrate was mainly composed of lymphocytes 8,9 . Therefore, whether they are trauma related or develop as a consequence of a degenerative phenomenon is unknown.…”

“…Bullous lesions in SE were described by Williams 8 in 1996 in two elderly patients involving heavily sun‐damaged skin. Since this original communication, very few additional cases have been reported 9,10 . In this study, we describe the clinical and histopathological features of a patient with this exceedingly rare condition named bullous solar elastosis (BSE).…”

“…BSE is exceedingly rare having been reported in four men and one woman, who ranged in age from 59 to 72 years 8–10 . It is characterized by asymptomatic or mildly pruritic yellowish or purpuric patches with overlying vesicles situated in zones of severe SE, especially the dorsum of the forearm 8,10 and, less frequently, the posterior neck 9 . The most prominent histopathological finding is the presence of a well‐defined, horizontally orientated cleft in the middle of a dermis that shows marked SE.…”

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“…A. Heras ausführlich beschrieben wird und durch dermale Spaltbildungen in chronisch lichtexponierter Haut charakterisiert wird. Ausschlusshalber wird in nicht eindeutigen Fällen empfohlen, eine noduläre Amyloidose sowie Erkrankungen aus dem Formenkreis der Muzinosen färberisch auszuschließen [3]. Vermutlich ist diese als bullöse solare Elastose bezeichnete morphologische Variation aufgrund des meist irrelevanten Befundes nur selten so benannt und diagnostiziert.…”