An 80-year-old fair-skinned man requests treatment for scattered hyperkeratotic patches on his face and hands, which have been diagnosed clinically as actinic keratoses. On examination, geometrically arranged furrows are found on the patient’s posterior neck. The condition is asymptomatic and of uncertain duration.
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Cutis rhomboidalis nuchae results from sun exposure on the posterior aspect of the neck. It is characterized by skin that is leathery, inelastic, and yellowish, with wrinkles that are arranged in a rhomboid shape.1
Cutis rhomboidalis nuchae is most likely to develop in those who have had heavy cumulative exposure to sunlight, including farmers, gardeners, lifeguards, or other outdoor workers. Ultraviolet radiation causes the elastic and collagen fibers in the dermis to degenerate.2 Cutis rhomboidalis nuchae is most often seen in older people, and severity depends on the amount of chronic sun exposure as well as on the patient’s constitutive skin color and capacity to tan.3 Interestingly, cutis rhomboidalis nuchae may protect the affected skin from actinic keratosis and nonmelanoma skin cancers.4
There is no treatment necessary for cutis rhomboidalis nuchae; however, the use of ultraviolet A/ultraviolet B sunscreens should be recommended.2
John Pappas is a medical student at the Geisinger Commonwealth School of Medicine in Scranton, Pennsylvania. Stephen Schleicher, MD, is an associate professor of medicine at the Commonwealth Medical College in Scranton, Pennsylvania, and an adjunct assistant professor of dermatology at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. He practices dermatology in Hazleton, Pennsylvania.
- Uitto J. Understanding premature skin aging. N Engl J Med. 1997;337:1463-1465.
- Wolff K, Johnson RA, Saavedra AP. Photosensitivity, photo-induced disorders, and disorders by ionizing radiation. In: Wolff K, Johnson RA, Saavedra AP, eds. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology. 7th ed. New York, NY: McGraw-Hill; 2013.
- Freedberg IM, Eisen AZ, Wolff K, et al., eds. Fitzpatrick’s Dermatology in General Medicine. 5th ed. New York, NY: McGraw-Hill; 1999:1606.
- Bonkevitch F, Souza PR. Cutis rhomboidalis protects skin from malignant epithelial tumors. Med Hypotheses. 2014;82:652-653.