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Solar comedo

Author: Dr Amanda Oakley MBChB FRACP, Dept of Dermatology Waikato Hospital, Hamilton, New Zealand, 1999.


Solar comedo — codes and concepts
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What is a solar comedo?

A solar or senile comedo (plural comedones) is a small skin coloured papule found on the face of a middle-aged or older person. Solar comedones affect areas that have been exposed to sunlight over a long period of time.

The comedones may be open (blackheads) or closed (whiteheads). They do not usually become inflamed. 

Solar comedones are not related to acne vulgaris

Solar comedones

Favre-Racouchot syndrome

Solar comedones and larger pseudocysts occur in association with solar elastosis, which causes yellowish, leathery skin and deep furrows. This appearance is also known as Favre-Racouchot syndrome. It may affect the skin around the eyes, the temples and the neck. Favre-Racouchot syndrome is thought to be due to a combination of sun exposure and heavy smoking.

Favre-Racouchot syndrome

Management of solar comedones

  • Use sun protection and apply oil-free sunscreen to exposed skin
  • Stop smoking
  • Wash affected areas twice daily with mild soap or cleanser and water
  • Apply retinoid cream to affected areas at night (this requires a doctor's prescription)
  • Apply light moisturisers if the skin is dry (dryness may be aggravated by the retinoid)
  • The contents of the comedones can be squeezed out gently using a "comedo expressor", an instrument which can be purchased at a pharmacy.

If these measures are unhelpful, the comedones can often be removed by electrocautery or laser ablation. They may recur and require further treatment from time to time.

 

Bibliography

  • Paganelli A, Mandel VD, Kaleci S, Pellacani G, Rossi E. Favre-Racouchot disease: systematic review and possible therapeutic strategies. J Eur Acad Dermatol Venereol. 2019;33(1):32-41. doi:10.1111/jdv.15184 PubMed 
  • Sobjanek M, Sławińska M, Biernat W. A case of unilateral inflamed plaques with comedones on the face: another case of an uncommon clinical presentation of Favre-Racouchot disease. Dermatol Pract Concept. 2019;9(4):308-9. doi:10.5826/dpc.0904a15 PubMed Central 
  • Sonthalia S, Arora R, Chhabra N, Khopkar U. Favre-Racouchot syndrome. Indian Dermatol Online J. 2014;5(Suppl 2):S128-9. doi:10.4103/2229-5178.146192 PubMed Central 

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