A Complication Of Prolonged Sun Exposure

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Cutis Rhomboidalis due to prolonged sun exposure

Long-term exposure to the sun can have multiple effects on the skin. One of the benign cutaneous complications is Cutis rhomboidalis nuchae.

Cutis rhomboidalis nuchae is a cutaneous condition of the posterior neck characterized by degeneration of the collagen and elastic tissue due to chronic sun exposure or the ultraviolet radiation of the sun. in medical jargon, the epidermis shows thickening and weathering, and the dermis undergoes solar elastosis.

CRN was once known as “sailor’s skin” or “farmer’s skin.”

Case presentation of a farmer with chronic sun exposure:

A 78-year-old male, farmer by profession, presented to the outpatient clinic after his relatives forced him, with complaints of thickened, heavily grooved skin on the back of his neck. The patient claimed these skin changes were present for an indeterminate period of time. Despite the skin changes, the patient had no other symptoms/complaints. The cutaneous changes were not associated with pain, itching, or any other clinical feature.

History did not reveal any family member with skin malignancy. Neither the patient had a history of any cancer. However, the patient gave a history of sun exposure for prolonged durations owing to the nature of his profession. He reported spending time farming, ranching, fishing, and tending to his property in rural Oklahoma, therefore, chronic sun exposure.

Physical Examination

On examination, the skin of the posterior neck was thickened and heavily lined. The lines merged forming overlapping rhomboidal shapes. But the examination didn’t reveal any skin discoloration. However, the thickened skin felt very thick and inflexible. These cutaneous changes had a sharp demarcation at the collar line, below which there were no changes.

Besides neck examination, the rest of the examination concurred with his sun exposure history, as the examination of his cheeks and ears revealed clinical manifestations of sun damage — including weathering, telangiectasias, solar lentiginosis, and numerous actinic keratoses. Moreover, dorsa of the hands exhibited similar findings bilaterally; but the examination of the arms and trunk was unremarkable. The patient reported wearing long-sleeved shirts when in the sun.

Diagnosis:

Owing to history and examination, the patient received a diagnosis of cutis rhomboidalis nuchae (CRN).

Who is more prone to CRN:

Fair-skinned, elderly individuals with chronic sun exposure are more prone to it.

Does CRN malignant potential:

Some studies conclude that CRN does not have malignant potential; instead, these suggest its role in protecting the nuchal skin from the malignant epithelial tumors. In contrast, other studies have established an association of CRN with actinic keratoses and basal cell carcinoma (BCC) of the skin.

What is the treatment of cutis rhomboidalis nuchae:

There are no approved treatment options for CRN; neither treatment is necessary. However, such patients should minimize/avoid sun exposure, wear sun-protective clothing, and use sunscreen (on the neck to prevent worsening of CRN). Since the chances of skin malignancies are higher in individuals with long-term sun exposure, it is best to have regular skin checks by a qualified dermatology provider at least once a year.

References:

Bonkevitch F, Souza PR. Cutis rhomboidalis protects the skin from malignant epithelial tumors. Med Hypotheses. 2014 Jun;82(6):652-3. doi: 10.1016/j.mehy.2014.02.006. Epub 2014 Feb 14. PMID: 24709066.

Joe Monroe, M. P. (2019, May 2). Cutis Rhomboidalis. Retrieved from Clinical Advisor: https://www.clinicaladvisor.com/home/case-files/cutis-rhomboidalis/

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Dr. Arsia Hanif has been a meritorious Healthcare professional with a proven track record throughout her academic life securing first position in her MCAT examination and then, in 2017, she successfully completed her Bachelors of Medicine and Surgery from Dow University of Health Sciences. She has had the opportunity to apply her theoretical knowledge to the real-life scenarios, as a House Officer (HO) serving at Civil Hospital. Whilst working at the Civil Hospital, she discovered that nothing satisfies her more than helping other humans in need and since then has made a commitment to implement her expertise in the field of medicine to cure the sick and regain the state of health and well-being. Being a Doctor is exactly what you’d think it’s like. She is the colleague at work that everyone wants to know but nobody wants to be. If you want to get something done, you approach her – everyone knows that! She is currently studying with Medical Council of Canada and aspires to be a leading Neurologist someday. Alongside, she has taken up medical writing to exercise her skills of delivering comprehensible version of the otherwise difficult medical literature. Her breaks comprise either of swimming, volunteering services at a Medical Camp or spending time with family.

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