By Gary M. White, MD
Sun damage and solar lentigines on the back.
See also wrinkling.
Mottled pigmentation, telantiectasias, solar elastosis and actinic keratoses after chronic sun exposure is characteristic. The balding scalp, face, back, arms and back of the hands are typical places. Comedones are also common with chronic UV exposure--see Favre-Racouchot syndrome.
Patients who smoke should quit. Daily morning sunscreen, a hat, sun avoidance and shade are recommended. Routine skin screen and biopsy of any suspicious lesions is critical. In one small study, sleep deprived women showed signs of premature skin aging [Dermatology Times Oct 2013]. Cosmetic options (e.g. topical retinoid, laser, chemical peel) abound and are beyond the scope of this book.
A DBPCT of a single course of topical 5% 5-FU cream BID x 2-4 weeks did not improve the signs of aging [JAMA Derm 2017;153;1142].
Mottled pigmentation on the dorsal hands.
Freckling of the knee.
Wrinkling. See smoker's face.
Tremendous photodamage and a basal cell carcinoma (the red spot).