http://s14/middle/a435ddd4xc1b4ddaeaf3d&690Dermatoheliosis.Jennifer RS Gordon,Joaquin C. Brieva.N Engl J Med 2012April ; 366:e25" TITLE="Unilateral Dermatoheliosis.Jennifer RS Gordon,Joaquin C. Brieva.N Engl J Med 2012April ; 366:e25" />

A 69-year-old man presented with a 25-year history of gradual, asymptomatic thickening and wrinkling of the skin on theleft side of his face. The physical examination showed hyperkeratosis with accentuated ridging, multiple open comedones, and areas of nodular elastosis.Histopathological analysis showed an accumulation of elastolytic material inthe dermis and the formation of milia within the vellus hair follicles.Findings were consistent with the Favre–Racouchot syndrome of photodamagedskin, known as dermatoheliosis. The patient reported that he haddriven a delivery truck for 28 years. Ultraviolet A (UVA) rays transmit throughwindow glass, penetrating the epidermis and upper layers of dermis. Chronic UVAexposure can result in thickening of the epidermis and stratum corneum, as wellas destruction of elastic fibers. This photoaging effect of UVA is contrastedwith photocarcinogenesis. Although exposure to ultraviolet B (UVB) rays islinked to a higher rate of photocarcinogenesis, UVA has also been shown toinduce substantial DNA mutations and direct toxicity, leading to the formationof skin cancer. The use of sun protection and topical retinoids and periodicmonitoring for skin cancer were recommended for the patient.

69岁男性脸部左侧皮肤呈现渐进性、无症状增厚及皱褶，病程25年。体格检查显示角化过度伴重叠性脊皱，群发性黑头粉刺，局部结节性弹力变性。组织病理学分析显示真皮处有弹力纤维溶解物质积累，毛囊处有粟丘疹形成。检查结果与光损伤皮肤（皮肤光老化）Favre–Racouchot综合征相吻合。患者司职货车司机28年。紫外线A (UVA)穿过玻璃辐射表皮及上层真皮。慢性UVA暴露可导致表皮及角质层肥厚化，伴随弹性纤维的变性。UVA的光老化效应与光致癌效应相对应。紫外线B (UVB)暴露可导致光致癌机率上升，然而UVA可诱导DNA物质突变并对其产生直接毒性，最终导致皮肤癌。建议对该患者进行必要的光保护，局部类视黄醇补充及皮肤癌定期监测。