8.10 Aged Skin
Grading & Level of Importance: B
Dermatoporosis (aged skin).
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.
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).
Intrinsic aging: inner side of the upper arm and the gluteal region.
Extrinsic aging: UV exposed sites (head and neck, hands).
- Intrinsic aging
- Extrinsic aging
Laboratory & other workups
Photographic severity scales, other imagine methods (laser profiling).
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
Gradual development in healthy individuals. In women, rapid progression after menopause.
Clinical signs, comparison of pictures from various phases of life.
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.
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