Actinic (solar) elastosis – understanding and treatment

Actinic elastosis is a skin condition caused by solar radiation that results in a form of dermatitis. Skin looks rough, thickened and wrinkled (leathery), with a yellowish hue, and possibly papules or discolouration.

This condition most often appears in an elderly or middle-aged person with a history of long-term sun exposure, but anyone exposed to the sun or UV light over a long period of time can be affected. This might include golfers, tennis players, farmers, those living and working on boats, and those who work outside. Anyone with fair skin is at a greater risk.

Actinic = caused by light
Elastosis = fragmented elastin fibres

Why does actinic elastosis happen?

It’s believed that after extensive UV exposure, changes in the skin occur that result in new collagen fibres being crowded in with the fragmented elastin fibres, where the elastin becomes coarse, twisted, branched and dense, causing masses in the top of the skin.

It is still under debate whether the elastic material is produced as part of a degrading process, or abnormal development of new tissue, or a combination of both. There may be a two-phase process occurring whereby normal elastic fibres collect in the dermis (top layer of skin), then elastic tissue degradation occurs. There are also theories that involve immune cells releasing enzymes that breakdown the collagen and elastin, causing the actinic elastosis.

Regardless, sun exposure causes inflammation which causes the degradation process. The main risks are skin cancer development and for some people, the appearance of it is displeasing.

Treatments for actinic elastosis

Actinic elastosis is treated with topical solutions, namely chemical peels. It can also be treated with skin resurfacing treatments such as dermabrasion or microdermabrasion, and other in-clinic dermatological treatments as required.

Lasers provide an excellent option, but downtime can be a concern, since the goal is to remove the layers of skin that are causing the appearance and cancer risk. A CO2 laser will cause the most downtime (three weeks), with fractional lasers taking about one week of recovery. Chemical peels of the right depth may take two weeks to recover from. The treatments require depths to be reached beyond a normal skin treatment. Photodynamic therapy uses light plus a photosensitiser. Prescription-only topical creams may be applied for rougher skin.

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