Clinical Challenge: Furrows and Thickened Skin on the Posterior Neck

Cutis rhomboidalis nuchae, also known as farmer’s or sailor’s neck, is a dermatologic condition that results from chronic sun exposure to the posterolateral aspect of the neck.1 The disorder most commonly manifests in individuals who have spent considerable time outdoors such...

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Cutis rhomboidalis nuchae, also known as farmer’s or sailor’s neck, is a dermatologic condition that results from chronic sun exposure to the posterolateral aspect of the neck.¹ The disorder most commonly manifests in individuals who have spent considerable time outdoors such as farmers, sailors, athletes, or mountain guides.² The condition is rare in women as the nape of the neck is typically protected by hair. Cutis rhomboidalis nuchae is one of the most well-recognized clinical variants of solar elastosis. It is characterized by degenerative changes in dermal elastic tissue as a result of photodamage.³

Cutis rhomboidalis nuchae presents as thickened, leathery skin with deep furrows in a rhomboid pattern on the nape of the neck.² The furrows are presumed to be a result of alterations in elastin and collagen fibers within sites of frequent flexion of the skin.⁴ Comedones may be present as well as trichostasis spinulosa, a condition characterized by a bundle of hair protruding from a single follicle.²

There is no ideal treatment, although topical application of a retinoid may improve appearance.² Clothing, hats, and use of sunscreen are recommended to protect against exposure to ultraviolet light when outdoors. Interestingly, cutis rhomboidalis nuchae may protect the affected skin from actinic keratoses and non-melanoma skin cancers.⁵

References

1. Lehmann P. Sun exposed skin disease. Clin Dermatol. 2011:29(2):180-188.
2. Braun-Falco O, Plewig G, Wolff HH, Winkelmann RK. Dermatology. 1st ed. Berlin: Springer Verlag; 1999:547.  
3. Heng JK, Aw DCW, Tan KB. Solar elastosis in its popular form: uncommon, mistakable. Case Rep Dermatol. 2014;6(1):124-128.  
4. Gilchrest, B. Skin and Aging Processes. 1st ed. Florida: CRC Press; 1984.
5. Bonkevitch F, Souza PRM. Cutis rhomboidalis protects skin from malignant epithelial tumors. Med Hypotheses. 2014;82(6):652-653.