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Favre-Racouchot Syndrome (Nodular Elastosis With Cysts and Comedones) Clinical Presentation

  • Author: Robert P Feinstein, MD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Sep 08, 2015
 

History

The patient will relate considerable sun exposure over a long period of time. Heavy smoking is also associated with Favre-Racouchot syndrome. Rarely, the patient will mention a past experience of radiation therapy.

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Physical

Multiple open and closed comedones are present in the periorbital and temporal areas. Rarely, the lateral neck, postauricular areas, and forearms may be involved. Severely actinic damaged skin with yellowish discoloration, yellowish nodules, atrophy, wrinkles, and furrows are present. The eruption is usually bilaterally symmetrical, although one side may predominate, particularly if that side experienced greater sun exposure. No inflammation is present, unlike the comedones seen in acne vulgaris.[3]

An actinic comedonal plaque-variant of Favre-Racouchot syndrome has been described. This variant presents with papules, cysts, and comedones producing a yellowish plaque in areas of chronic sun-damaged skin. Two cases from Brazil are presented. The involvement is usually on the forearms and chest, with UV light exposure being the main factor in its pathogenesis.[4]

 

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Causes

Although the precise pathogenesis of the disorder is unknown, it develops in individuals with a heavy smoking history and chronic exposure to UV light.[5] Recently, Vogel et al described a case of unilateral Favre-Racouchot syndrome indicating the etiologic role of chronic solar damage in this disease.[6]

The disorder also may follow exposure to radiation therapy.[7, 8] This was illustrated in a paper by Hoff et al, in which a 71-year-old man treated with radiation therapy for a malignant melanoma of the right paranasal sinus. He subsequently developed elastosis, open and closed comedones, and cysts in the radiation field.[9]

Lim et al, in a discussion of the adverse effects of UV radiation from the use of indoor tanning equipment, has cited Favre-Racouchot syndrome as one of these adverse effects.[10]

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Contributor Information and Disclosures
Author

Robert P Feinstein, MD Associate Clinical Professor, Department of Dermatology, Columbia University College of Physicians and Surgeons

Robert P Feinstein, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Noah Worcester Dermatological Society, Phi Beta Kappa

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Edward F Chan, MD Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine

Edward F Chan, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Andrea Leigh Zaenglein, MD Professor of Dermatology and Pediatrics, Department of Dermatology, Hershey Medical Center, Pennsylvania State University College of Medicine

Andrea Leigh Zaenglein, MD is a member of the following medical societies: American Academy of Dermatology, Society for Pediatric Dermatology

Disclosure: Received consulting fee from Galderma for consulting; Received consulting fee from Valeant for consulting; Received consulting fee from Promius for consulting; Received consulting fee from Anacor for consulting; Received grant/research funds from Stiefel for investigator; Received grant/research funds from Astellas for investigator; Received grant/research funds from Ranbaxy for other; Received consulting fee from Ranbaxy for consulting.

References
  1. Favre M. Sur une kystique des appareils pilo-sebaces localis ertaines r'ons de la face. Bull Soc Fr Dermatol Syph. 1932. 39:93-6.

  2. Favre M, Racouchot J. [Nodular cutaneous elasteidosis with cysts and comedones.]. Ann Dermatol Syphiligr (Paris). 1951 Nov-Dec. 78(6):681-702. [Medline].

  3. Patterson WM, Fox MD, Schwartz RA. Favre-Racouchot disease. Int J Dermatol. 2004 Mar. 43(3):167-9. [Medline].

  4. Cardoso F, Nakandakari S, Zattar GA, Soares CT. Actinic comedonal plaque-variant of Favre-Racouchot syndrome: report of two cases. An Bras Dermatol. 2015 Jun. 90 (3 Suppl 1):185-7. [Medline].

  5. Keough GC, Laws RA, Elston DM. Favre-Racouchot syndrome: a case for smokers' comedones. Arch Dermatol. 1997 Jun. 133(6):796-7. [Medline].

  6. Vogel S, Muhlstadt M, Molin S, Ruzicka T, Schneider J, Herzinger T. Unilateral favre-racouchot disease: evidence for the eiological role of chronic solar damage. Dermatology. 2013. 226:32-4. [Medline].

  7. Breit S, Flaig MJ, Wolff H, Plewig G. Favre-Racouchot-like disease after radiation therapy. J Am Acad Dermatol. 2003 Jul. 49(1):117-9. [Medline].

  8. Friedman SJ, Su WP. Favre-Racouchot syndrome associated with radiation therapy. Cutis. 1983 Mar. 31(3):306-10. [Medline].

  9. Hoff NP, Reifenberger J, Boike E, Homey B, Gerber PA. Radiation-induced Favre-Racouchot disease. Hautarzt. Oct., 2012. 10:766-7. [Medline].

  10. Lim HW, James WD, Rigel DS, Maloney ME, Spencer JM, Bhushan R. Adverse effects of ultraviolet radiation from the use of indoor tanning equipment: time to ban the tan. J Am Acad Dermatol. 2011 May. 64(5):893-902. [Medline].

  11. Adams BB, Chetty VB, Mutasim DF. Periorbital comedones and their relationship to pitch tar: a cross-sectional analysis and a review of the literature. J Am Acad Dermatol. 2000 Apr. 42(4):624-7. [Medline].

  12. Morgan MB, Stevens GL, Somach S. Multiple follicular cysts, infundibular type with vellus hairs and solar elastosis of the ears: a new dermatoheliosis?. J Cutan Pathol. 2003 Jan. 30(1):29-31. [Medline].

  13. Lewis KG, Bercovitch L, Dill SW, Robinson-Bostom L. Acquired disorders of elastic tissue: part I. Increased elastic tissue and solar elastotic syndromes. J Am Acad Dermatol. 2004 Jul. 51(1):1-21; quiz 22-4. [Medline].

  14. Sanchez-Yus E, del Rio E, Simon P, Requena L, Vazquez H. The histopathology of closed and open comedones of Favre-Racouchot disease. Arch Dermatol. 1997 Jun. 133(6):743-5. [Medline].

  15. Kligman AM, Plewig G, Mills OH Jr. Topically applied tretinoin for senile (solar) comedones. Arch Dermatol. 1971 Oct. 104(4):420-1. [Medline].

  16. Sharkey MJ, Keller RA, Grabski WJ, McCollough ML. Favre-Racouchot syndrome. A combined therapeutic approach. Arch Dermatol. 1992 May. 128(5):615-6. [Medline].

  17. English DT, Martin GC, Reisner JE. Dermabrasion for nodular cutaneous elastosis with cysts and comedones. Favre-Racouchot syndrome. Arch Dermatol. 1971 Jul. 104(1):92-3. [Medline].

  18. Mohs FE, McCall MW, Greenway HT. Curettage for removal of the comedones and cysts of the Favre-Racouchot syndrome. Arch Dermatol. 1982 May. 118(5):365-6. [Medline].

  19. Mavilia L, Campolmi P, Santoro G, Lotti T. Combined treatment of Favre-Racouchot syndrome with a superpulsed carbon dioxide laser: report of 50 cases. Dermatol Ther. 2010 Jan-Feb. 23 Suppl 1:S4-6. [Medline].

  20. Rai S, Madan V, August PJ, Ferguson JE. Favre Racouchot Syndrome; A novel two- step treatment approach using the carbon dioxide laser. Br J Dermatol. Nov 2013. [Full Text].

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