Review Question - QID 217222

This patient with extensive sun exposure (i.e., farmer) who presents with rough texture, abundant wrinkles, and diffuse mottled pigmentation of the skin most likely has photoaging. Histologically, this can be seen as flattening of dermal papillae with basophilic depositions representing denatured elastic fibers.

Photoaging of the skin occurs when patients are exposed to UV radiation for prolonged periods of time over the course of years. It is most commonly seen in patients with occupations that require significant sun exposure such as farmers or construction workers. Over time, UV radiation degrades elastic fibers in the skin and results in their replacement with collagen in a process known as solar elastosis. Clinically, this can be seen by the loss of skin elasticity and the accumulation of wrinkles that do not disappear with stretching. In addition, patients with photoaging may also have diffuse accumulation of skin changes such as solar lentigos and poikiloderma. Histologically, solar elastosis will present with flattening of dermal papillae with basophilic depositions representing denatured elastic fibers.

Kang et al. present a review of the pathophysiology and treatment of patients with photoaging. They find that topical tretinoin treatment may prevent photoaging of the skin.

Incorrect Answers:
Answer 1: Atypical nests of basophilic palisading cells in the dermis would be seen in patients with basal cell carcinoma of the skin; however, this condition would present as pink, pearly dome-shaped nodules or papules with overlying arborizing telangiectasias.

Answer 2: Atypical squamous epithelial cells extending into the dermis would be seen in patients with squamous cell carcinoma of the skin; however, this disease would present with a red, poorly defined base with adherent yellow or white scale.

Answer 4: Nests of melanocytes of varying sizes and shapes in all skin layers would be seen in patients with melanoma; however, this condition would present with pigmented lesions that are large, asymmetric, variegated in color, with irregular borders.

Answer 5: Partial thickness dysplasia of the epidermis with keratinocyte atypia would be seen in patients with actinic keratosis; however, actinic keratosis would present as erythematous macules that are transparent or yellow with a rough, “sand-paper” texture.

Bullet Summary:
Photoaging of the skin can be seen on histology as flattening of the dermal papillae with basophilic depositions.