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Cutis rhomboidalis nuchae - Skin
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Cutis rhomboidalis nuchae - Skin

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Contributors: Stephen Huang MD, Whitney A. High MD, JD, MEng, Jeffrey D. Bernhard MD, Noah Craft MD, PhD, Lindy P. Fox MD, Lowell A. Goldsmith MD, MPH, Michael D. Tharp MD
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Synopsis

Cutis rhomboidalis nuchae (CRN) is a harmless cutaneous condition of the posterior neck characterized by deep furrowing in a geometric pattern. The condition is a marker of chronic sun damage with the subsequent development of disorganized and damaged collagen and elastic tissue.

CRN is a disease chiefly of elderly men and women with a lighter skin tone and a history of significant sun exposure. The condition involves the nape of the neck or the décolleté area and consists of intersecting and exaggerated skin folds that produce quadrangular and rhomboidal shapes. There is often a leathery quality to the involved skin.

CRN is a chronic condition, and once the skin changes have occurred, it is difficult, if not impossible, to reverse the appearance of the skin. In this regard, prevention, such as using sunscreens and other protective measures, is the best advice.

Codes

ICD10CM:
L57.2 – Cutis rhomboidalis nuchae

SNOMEDCT:
89019003 – Cutis rhomboidalis nuchae

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Lichen simplex chronicus – In this condition, caused by chronic scratching of pruritic skin, the lines are not as furrowed and a history of intense pruritus and rubbing is elicited.
  • Systemic amyloidosis – May also lead to ridging/thickening of skin, but there is often a more intense erythema in comparison to CRN. Amyloidosis of the skin may be accompanied by enlargement of the tongue. A biopsy will demonstrate amyloid deposition, particularly with special stains such as Congo red.
  • Favre-Racouchot syndrome (FRS) – Another manifestation of chronic sun damage with acneiform lesions and agminated comedones. FRS is more responsive to topical retinoids.
  • Psoriasis – This inflammatory skin disorder manifests as pink to red erythematous, well-demarcated plaques with a silvery and micaceous scale. Psoriasis tends to involve the occipital scalp, which is relatively protected from the sun by hair and not involved in CRN.

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Therapy

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Last Updated: 01/23/2015
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Cutis rhomboidalis nuchae - Skin
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Cutis rhomboidalis nuchae : Chronic duration lasting years, Posterior neck, Thickened skin
Clinical image of Cutis rhomboidalis nuchae
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