Nodular elastosis with cysts and comedones, a severe unilateral presentation

Abstract

Case presentation. A 73-year-old patient with a history of chronic occupational exposure to solar radiation and smoking for 54 years; he consulted for a unilateral dermatosis on the face with a yellowish multicystic tumor appearance, accompanied by open and circumscribed comedones, involving zygomatic, infraorbital, and left cheek regions, of 25 years of evolution, with little pruriginosity and mild body dysmorphic symptoms.Treatment. Clinical and dermatoscopic findings and a skin biopsy made the diagnosis. Management was performed on an outpatient basis, including education regarding the disease, as well as measures to avoid, abandon, or reduce aggravating factors, in addition, permanent sun protection and a combination of alpha hydroxy acids with topical retinoids were prescribed. Outcome. This dermatosis is characterized by a chronic, non-resolving course with no tendency to malignant transformation. The main approaches are surgical and pharmacological; the former for severe cases, as the one described in this report. In the Plastic Surgery Department, surgical excision of the lesions was performed in two stages, with ambulatory follow-up in dermatology due to the high incidence rate of malignant neoplasms, inherent in skin with chronic actinic damage.