A Guide to Aging Skin
The appearance of the skin contributes to the psychological needs of an individual. In our culture, a young skin contributes to beauty and social acceptance. Aged skin is an alienating factor which may minimize an individual’s self-esteem. In the 21st Century, 20% of the population of developed nations will be 65 years old or older. Consequently, there is a greater demand for study of age related skin changes to quantify the degree of aging. Cosmetic preparations become more sophisticated as we incorporate active agents with advanced delivery systems which challenge the aggressions of time.
There are two classes of aging: Intrinsic(chronological) and photoaged (sun damaged). The changes in mature, sun-exposed skin has unique clinical and histolic features that are not observed in sun-protected skin. Clinical changes in skin that has been protected are relatively subtle and consist primarily of fine wrinkling, laxity, and a broad variety of benign neoplasms (excess tissue growth).
Intrinsic Aging and Photoaging
|Skin Texture||Smooth||Rough, leathery|
|Wrinkling||Fine||Fine and coarse|
|Color||Pale||Yellowish mottled hyperpigmentation, telangiectasia, purpura|
|Neoplasms||Benign||Premalignant and malignant|
Manifestations of cutaneous aging, as it relates to perception of age, is caused by actinic damage (sun). In photoaged skin, there are numerous changes that are superimposed on the alterations of intrinsic aging such as coarsening, deep wrinkling and furrowing, hyperpigmentation, actinic keratosis along with a tendency to develop premalignant and malignant neoplasms. Photoaged skin results in the thickening of the epidermis and irregular synthesis and restructuring of the collagen and elastin decomposition, which gives a tough, non-elastic appearance to the skin.
The collagen network makes up 80% of the dermis. In youth the cutaneous support structure is firm, has flexibility and mobility. When skin is subjected to cumulative solar exposure and other environmental assaults, the cells’ nucleic material is effected so that reproduction of healthy cells is altered resulting in irreparable damage to cell membranes.
Understanding the characteristics associated with each individual skin type which include depth of pigment, genetic traits, age and general health will contribute greatly to the end results of a procedure. Categorizing a patient’s skin assists in determining the selection of and tolerance level of epidermal peels, the potential for pigmentation, scaring and healing. Specific guidelines associated with peel depths, laser resurfacing, and surgical procedures are modified according to the individual patient.
Fitzpatrick Classification Table
|I||White||Always burns, never tans|
|II||White||Usually burns, tans less than average|
|III||White||Sometimes mild burn, tans about average|
|IV||White||Rarely burns, tans more than average|
|V||Brown||Rarely burns, tans profusely|
|VI||Black||Never burns, deeply pigmented|
Recent scientific data has shed some light on the aging process. Before a cell divides, it copies its chromosomes to give each new cell a complete set. In most cells, however, this process does not include the long spirals of DNA called telomeres, which protect the ends of every chromosome. Telomeres get shorter with each cell division. Finally, some scientists believe, they are so short that the cell can no longer divide, and it becomes vulnerable to damage and decay.