Solar Elastotic Bands of the Forearm: An Extremely Rare Presentation

A 56-year-old Indian female with skin Fitzpatrick type- V is presented with erythematous nodules and plaques on her upper extremities for the past two years. The lesions were asymptomatic and progressive. She had an occupational history of long-term exposure to sunlight. No other cutaneous areas had similar skin lesions. The local cutaneous examination revealed hyperpigmentation and slightly erythematous, edematous, and smooth papulonodular lesions on the extensor surface of both her forearms. These lesions were coalescing into plaques, giving a mammillated appearance and some of them were seen to be arranged in irregular cord-like bands (Extension Extension to the medial and lateral sides of forearms were observed. The purpuric macules were also present. General and systemic examination were unremarkable. Routine laboratory parameters were also within normal limits. Histopathologic examination (HPE) on Hematoxylin and Eosin (H & E) staining revealed epidermal atrophy with effacement of the rete ridges. Dermis showed cleftlike spaces and bundles of degenerated elastic fibers composed of basophilic, granular materials in the dermis (Figure 2A and B). Spindle-shaped fibroblasts were seen along with mild perivascular lymphocytic infiltrates. Verhoeff Van-Gieson staining and electron microscopic studies could not be done due to the limited resources of the institution. Although, elastotic changes in the skin of forearm are rarely reported, the histopathological findings were consistent with the diagnosis of solar elastosis. Therefore, we concluded with the diagnosis of solar elastotic bands of the forearm. Solar elastosis is a pathological hallmark of photoageing, often seen as deposition of abnormal, amorphous granular materials within the dermis (1). Although, the exact origin of such materials is not determined, it has been attributed to both the degeneration of elastin fibers caused by chronic exposure of ultraviolet A rays and synthesis of abnormal elastin fibers by photodamaged fibroblasts (1). It leads to peculiar cutaneous changes such as hyperpigmentation, atrophy, thickening, telangiectasia, purpura, coarsening, wrinkling, and poikiloderma. It may also lead to development of some skin lesions, most commonly colloid milium, cutis rhomboidalis nuchae, Favre- Racouchot syndrome, elastotic striae, papular elastosis and anetoderma, and less commonly as acrokeratoelastoidosis of marginalis, elastosis linearis rubra nasi, upper and mid dermal elastolysis.