Derm Dx: Wrinkly, yellow skin and blackheads - Clinical Advisor

Derm Dx: Wrinkly, yellow skin and blackheads

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  • Favre Racouchot 1_0113 Derm Dx

  • Favre Racouchot 2_0113 Derm Dx

A 65-year-old man presents for an annual skin check. He has a history of several basal cell skin cancers, and 50-pack-year history of cigarette smoking. The patient complains of yellowish, wrinkled skin and clogged pores on his cheekbones and temples.

Favre-Racouchot syndrome, also called nodular elastoidosis with cysts and comedones, is a common sign of photoaging, or cutaneous changes associated with chronic sun exposure.Thickened, yellow plaques studded with open and closed comedones and small epidermal inclusion cysts are characteristic of...

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Favre-Racouchot syndrome, also called nodular elastoidosis with cysts and comedones, is a common sign of photoaging, or cutaneous changes associated with chronic sun exposure.

Thickened, yellow plaques studded with open and closed comedones and small epidermal inclusion cysts are characteristic of Favre-Racouchot. The condition occurs on chronically sun-exposed skin, as evidenced by deep wrinkles and furrows. The most common location is around the eyes and temples, with the pattern usually fairly symmetrical. Favre-Racouchot may also occasionally occur on the forearms, behind the ears and on the lateral neck. 

Most patients are white men with a significant smoking history. Patients frequently present with multiple other signs of photoaging and are at risk for developing skin cancers, particularly basal cell and squamous cell carcinomas. Smoking appears to be a risk factor for Favre-Racouchot.

Solar elastosis, dilated and plugged follicles, and milia are histological characteristics of Favre-Racouchot. Poikiloderma of Civatte and cutis rhomboidalis nuchae are other sequelae of photoaging.

Cutis rhomboidalis nuchae refers to thickened and leathery skin on the posterior neck with exaggerated skin markings that form fissures or furrows in a crisscross pattern. There is often a yellowish hue to the skin.  The typical patient has a fair complexion and has had significant exposure to sunlight. 

Poikiloderma of Civatte is characterized by reddish to brownish patches with telangiectasias appearing on the lateral aspects of the neck. The lower anterior neck and “V” area of the superior chest may also be affected. Characteristically, the skin of the central neck immediately below the chin is spared. 

Other examples of photoaging include colloid millium, solar purpura, solar lentigines and stellate pseudoscars. Colloid millium are translucent, yellowish papules that occur on sun-exposed areas of the face, neck and dorsal hands.

Patients with solar purpura bruise easily due to solar damage to the connective tissues of the skin. They typically present with purplish bruising on the forearms and dorsal hands that subsequently fades to a brownish discoloration.  

Solar lentigines, also called liver spots, are irregular brown macules that occur on sun-exposed areas, especially the dorsal arms, forearms and V-area of the chest and face, whereas stellate pseudoscars consist of white scar-like plaques that present most commonly on the dorsal forearms. 

Diagnosis & Treatment

Favre-Racouchot is easily recognized by the presence of yellowish, thickened skin with open and closed comedones on the temples and periorbital skin. Patient will have a history of excessive sun exposure and are usually current or former smokers. Biopsy is rarely necessary.     

Treatment options for Favre-Racouchot include topical retinoids, dermabrasion and comedone extraction. As with all forms of photodamage, prevention is paramount since treatment is usually less than satisfying. 

Adam Rees, MD, is a graduate of the University of California Los Angeles School of Medicine and a resident in the Department of Dermatology at Baylor College of Medicine in Houston.

References

  1. Bolognia J, Jorizzo JL, Rapini RP. Dermatology. “Chapter 86: Photodermatoses.” St. Louis, Mo.: Mosby/Elsevier, 2008.
  2. James WD, Berger TG, Elston DM et al. Andrews’ Diseases of the Skin: Clinical Dermatology. “Chapter 3: Dermatoses Resulting from Physical Factors.” Philadelphia: Saunders Elsevier, 2006.
  3. Feinstein RP et al.  Favre-Racouchot Syndrome. Medscape. Last updated July 9, 2012. Accessed January 1, 2013.
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