Derm Dx: Furrows and Thickened Skin on the Posterior Neck - Clinical Advisor

Derm Dx: Furrows and Thickened Skin on the Posterior Neck

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An 85-year-old man presents with bilateral ankle swelling and redness that has been diagnosed as stasis dermatitis. An incidental finding of well-demarcated furrows and thickened skin of the posterior neck is noted. The patient was unaware of these findings as they are asymptomatic. He has worked as a farmer his entire life.

Can you diagnose this condition?

Cutis rhomboidalis nuchae, also known as farmer’s or sailor’s neck, is a dermatologic condition that results from chronic sun exposure to the posterolateral aspect of the neck.1 The disorder most commonly manifests in individuals who have spent considerable time outdoors...

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Cutis rhomboidalis nuchae, also known as farmer’s or sailor’s neck, is a dermatologic condition that results from chronic sun exposure to the posterolateral aspect of the neck.1 The disorder most commonly manifests in individuals who have spent considerable time outdoors such as farmers, sailors, athletes, or mountain guides.2 The condition is rare in women as the nape of the neck is typically protected by hair. Cutis rhomboidalis nuchae is one of the most well-recognized clinical variants of solar elastosis. It is characterized by degenerative changes in dermal elastic tissue as a result of photodamage.3

Cutis rhomboidalis nuchae presents as thickened, leathery skin with deep furrows in a rhomboid pattern on the nape of the neck.2 The furrows are presumed to be a result of alterations in elastin and collagen fibers within sites of frequent flexion of the skin.4 Comedones may be present as well as trichostasis spinulosa, a condition characterized by a bundle of hair protruding from a single follicle.2

There is no ideal treatment, although topical application of a retinoid may improve appearance.2 Clothing, hats, and use of sunscreen are recommended to protect against exposure to ultraviolet light when outdoors. Interestingly, cutis rhomboidalis nuchae may protect the affected skin from actinic keratoses and non-melanoma skin cancers.5

References

  1. Lehmann P. Sun exposed skin disease. Clin Dermatol. 2011:29(2):180-188.
  2. Braun-Falco O, Plewig G, Wolff HH, Winkelmann RK. Dermatology. 1st ed. Berlin: Springer Verlag; 1999:547.  
  3. Heng JK, Aw DCW, Tan KB. Solar elastosis in its popular form: uncommon, mistakable. Case Rep Dermatol. 2014;6(1):124-128.  
  4. Gilchrest, B. Skin and Aging Processes. 1st ed. Florida: CRC Press; 1984.
  5. Bonkevitch F, Souza PRM. Cutis rhomboidalis protects skin from malignant epithelial tumors. Med Hypotheses. 2014;82(6):652-653.
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