Aged Skin

Synonyms

Dermatoporosis (aged skin).

Epidemiology

Ethnicity-specific aging characteristics.

Caucasians: greater skin wrinkle formation and sagging
Asians: Pigment spot intensity.

Professional extrinsic characteristic: indoor vs outdoor workers; nutritional and living behaviours.

Definition

Natural process of biochemical and immunological events, leading to gradual cell damage accumulation, decreased local immune response and development of various benign or malignant skin changes or diseases.

Aetiology & Pathogenesis

Genetic predisposition, impairment of cellular metabolic and immunologic pathways, qualitative and quantitative hormonal alterations (intrinsic aging) and natural or artificial ultraviolet irradiation, stress, smoking, alcohol, chemicals and toxins, pollution (extrinsic aging).

Signs & Symptoms

Intrinsically aged skin: macroscopically thin and atrophic skin, exhibits fine wrinkles, subcutaneous fat loss, prominent dryness and reduced elasticity.

Extrinsically aged skin: deeper wrinkles, thickening of the epidermis varying, dullness, roughness and mottled discoloration. Telangiectasias (severe photoaging).

Localisation

Intrinsic aging: inner side of the upper arm and the gluteal region.

Extrinsic aging: UV exposed sites (head and neck, hands).

Classification

- Intrinsic aging

- Extrinsic aging

Laboratory & other workups

Photographic severity scales, other imagine methods (laser profiling).

Dermatopathology

Light-protected skin: Epidermal thinning (10–50%), decreased mitotic activity, decrease of Langerhans cells, reduction of dermal thickness, atrophy of the extracellular matrix, decrease of skin appendages, thinning of subcutaneous fat.

Light-exposed skin: Epidermal thickening varying, impaired proliferation, and differentiation of keratinocytes, sparce distribution of collagen fibers, broken elastic fibers and accumulation (actinic elastosis) increased mast cells and neutrophils, marked regression and loss of vascular pattern

Course

Gradual development in healthy individuals. In women, rapid progression after menopause.

Complications

Increased vulnerability.

Diagnosis

Clinical signs, comparison of pictures from various phases of life.

Differential diagnosis

Progeria syndromes, hormonal deficiencies, metabolic disturbances (internal diseases).

Prevention & Therapy

Consequent avoidance of overexposure to extrinsic factors, diagnosis and treatment of underlying internal diseases (the skin is mirror of the body).

Various medico- cosmetic and surgical procedures.

8.10 Aged Skin