Skin Aging

We are all quite cautious of the skin changes we will get as we age. But what is aging? And What does this entail?

Our skin undergo extrinsic and intrinsic changes. Intrinsic aging, also known as chronological ageing affects the skin of the entire body, including sun-protected sites.

Extrinsic ageing is induced by external factors, such as chronic ultraviolet (UV) radiation exposure, cigarette smoking, and other pollutants. This is superimposed on the natural instrinsic aging process.

Intrinsic ageing affects everyone, whatever their skin type. Extrinsic ageing affects areas of skin which are chronically exposed to sunlight — this is known as sun damage or photoageing.

Who is more susceptible?

• Fair skin- Fitzpatrick sun-reactive skin types I-II

• Living in the tropics or subtropics

• Live at high altitudes

• Work outdoors or spend long periods outdoors for recreation

• Exposed to artificial sources of UV radiation, such as tanning beds

• Genetic predisposition (eg, progeria)

• Poor nutrition, eg. lack of vitamins C and A in diet can also influence extrinsic ageing

Clinical features of skin ageing:

Intrinsic ageing:

There is an increased incidence of:

• Noncancerous skin growths (eg. Sebhorreic keratosis, keratoacanthoma)

• Cancerous growths such as BCC and SCCs

• Skin tags, warts, liver spots, solar lentigo

• Wrinkles due to decreased elastin synthesis which shows skin laxity and rigidity

• Decreased collagen synthesis : atrophy of the dermis

• Decreased subdermal fat -> skin sagging
  

Figure 1: Solar Lentigo (L), DermNetNZ;  Seborrheic Keratosis (R), Medscape

• Wrinkles, laxity, pigment changes, neoplasms.

Figure 2: Senile Purpura

Senile purpura: recurrent, irregularly shaped and dark macules. More common in light-skinned individuals, on sun exposed areas

Extrinsic ageing/ photoageing:

• Sun-induced cutaneous changes,

• Dyspigmentation, hyperpigmentation, malignant skin lesions

• Solar elastosis: age-related cutaneous changes characterised by the development of diffusely thickened and wrinkled skin, may have yellow discolouration.

• Caused by accumulated damaged collagen and elastic tissue, as a redult of UV exposure.

Figure 3: Solar elastosis with yellow discoulouration, Primary Care Dermatology Society

Prevention:

• UV protection

• Avoid Smoking

• Diet and exercise

References:

1.     Skin ageing [Internet]. Available from: https://dermnetnz.org/topics/ageing-skin

2.     Massie, Jonathan & Cho, Daniel & Kneib, Cameron & Burns, Jacob & Crowe, Christopher & Lane, Megan & Shakir, Afaaf & Sobol, Danielle & Sabin, Janice & Sousa, Janelle & Rodriguez, Eduardo & Satterwhite, Thomas & Morrison, Shane. (2019). Patient Representation in Medical Literature: Are We Appropriately Depicting Diversity?. Plastic and Reconstructive Surgery - Global Open. 7. 1. 10.1097/GOX.0000000000002563.

3.     Arthur K Balin M. Seborrheic keratosis [Internet]. Medscape; 2021. Available from: https://emedicine.medscape.com/article/1059477-overview#a4

4.     Primary Care Dermatology Society. Solar elastosis (syn. actinic elastosis) [Internet]. Available from: https://www.pcds.org.uk/clinical-guidance/solar-elastosis

5.  Primary Care Dermatology Society. Hyperpigmentation - of the face and neck [Internet]. [cited 2024 Feb 29]. Available from: https://www.pcds.org.uk/clinical-guidance/melasma-syn-chloasma-and-other-causes-of-facial-hyperpigmentation

6. Farage M, Miller K, Maibach H, Howard I (eds). Textbook of aging skin. Berlin/Heidelberg: Springer-Verlag, 2010.