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Author: Dr Jean Ayer, Consultant Dermatologist, University of Manchester, Manchester, United Kingdom. DermNet NZ Editor in Chief: Adjunct A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand. Copy edited by Maria McGivern/Gus Mitchell. June 2018.
There are two types of ageing processes: intrinsic and extrinsic ageing.
Intrinsic ageing affects everyone, whatever their skin type. Extrinsic ageing affects people who are chronically exposed to sunlight — this is known as sun damage or photoageing. People who typically present with marked signs of photoageing include those who:
Premature ageing of the skin also affects tobacco smokers and those who have been chronically exposed to other environmental pollutants.
Intrinsic ageing is defined by the clinical, histological and physiological changes that occur in sun-protected areas of skin of older individuals. Intrinsic ageing can be compounded by other environmental factors.
UV radiation attacks the integrity of the skin.
The signs of intrinsic ageing begin at around 50–60 years of age. Women develop these signs earlier than men, which is attributed to a decrease in the protective effects of oestrogen during menopause.
Smoking exposes the skin to several damaging factors.
Nutrition is known to affect extrinsic ageing.
Intrinsically aged skin appears dry and pale, smooth, thin, transparent, and unblemished.
Extrinsic ageing, such as photoageing, is related to environmental factors. Extrinsic ageing was first reported at the end of the 19th century, and was then described as 'farmer's skin' or 'sailor’s skin'.
Sun-induced cutaneous changes vary considerably among individuals, reflecting inherent differences in vulnerability to sun exposure and repair capacity. Even among Caucasians, the appearance of photoaged skin of individuals with skin phototypes I–III often differs from that of individuals with skin phototypes IV–VI.
|Skin type||Skin colour||Effect of UV|
|I||White or freckled skin||Always burns, never tans|
|II||White skin||Usually burns, tans poorly|
|III||Olive skin||Sometimes burns mildly, gradually tans|
|IV||Light brown skin||Rarely burns, tans easily|
|V||Dark brown skin||Very rarely burns, tans very easily|
|VI||Black skin||Never burns, tans very easily|
The degree of photoageing is significantly affected by an individual’s ethnicity and Fitzpatrick phototype. Fair-skinned individuals of Northern European descent (Fitzpatrick phototypes I–III) are more prone to photoageing than individuals with skin of colour (Fitzpatrick phototypes IV–VI, which include people of African, African-American, Asian, and Latino or Hispanic descent), with melanin affording protection against sun-induced damage.
In white Caucasians, severe facial photoageing tends to result in two phenotypes:
Individuals with Fitzpatrick phototypes III (and, to some extent, phototype IV skin) tend to show hypertrophic responses; while those with phototypes I and II tend towards the atrophic phenotype.
|Features||Atrophic photoageing||Hypertrophic photoageing|
|Texture||Smooth, thin||Rough, leathery|
|Appearance||Shiny skin||Sallow skin|
|Vasculature||Telangiectasia and senile purpura are common||Minimal, or absent, vascular changes|
|Dysplastic changes||Actinic keratoses, basal cell carcinomas, and squamous cell carcinomas are common||Actinic keratoses, basal cell carcinomas, and squamous cell carcinomas are uncommon|
|Other||Poikiloderma of Civatte||Associated with Favre-Racouchot syndrome|
Dermatoporosis is a term used to describe chronic cutaneous insufficiency and fragility associated with both intrinsic and extrinsic ageing. The features of dermatoporosis include:
The features of ageing skin are diagnosed clinically. Lesions suspicious of skin cancer present as growing lumps or sores that fail to heal. Such lesions often undergo diagnostic biopsy before or as part of treatment.
Procedures that aim to rejuvenate photoaged skin include:
Intrinsic ageing is inevitable. In perimenopausal women, systemic hormone replacement may delay skin thinning; the skin is less dry, with fewer wrinkles, and wound healing is faster than prior to treatment. Hormone replacement is less effective at improving skin ageing in the postmenopausal decades. The effects of topical oestrogens, phyto-oestrogens, and progestins are under investigation.
Protection from solar UV is essential at all ages. There are several steps that can be taken to minimise or avoid UV exposure.
Many oral supplements with antioxidant and anti-inflammatory properties have been advocated to retard skin ageing and to improve skin health. These include carotenoids; polyphenols; chlorophyll; aloe vera; vitamins B, C, and E; red ginseng; squalene; and omega-3 fatty acids. Their role in combatting skin ageing is unclear.
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