Forum for Nordic Dermato-Venereology Nr 2, 2018 | Page 6

Educational Review Skin Ageing and Dermatoporosis N icolas K luger , R egional E ditor , F inland Helsinki University Central Hospital and University of Helsinki, Dermatology, Allergology and Venereology, FIN-00029 Helsinki, Finland. E-mail: [email protected] Dermatoporosis is a recent term that defines the clinical and functional aspects of chronic cutaneous insufficiency/ fragility syndrome related to skin ageing. Dermatoporosis is frequently seen in geriatric medicine. It mainly affects patients in the age range 70–90 years, and leads to impor- tant functional disabilities and high management costs. Management of dermatoporosis involves the prevention of trauma in elderly patients. Topical treatments, such as hyaluronic acid and retinaldehyde, may help to correct the skin atrophy. Topical vitamin C has recently proved beneficial in this indication. Key words: ageing; dermatoporosis; fragility; haematoma; hyaluronic acid; purpura; vitamin C. Skin ageing Skin ageing is an unavoidable natural process, which varies considerably from one individual to another, depending on genetic/ethnic and environmental factors (mainly sun exposure and tobacco consumption) (1). Chronological or intrinsic age- ing is responsible for skin that gradually thins, dehydrates and depigments, appearing withered, with a loss of elasticity (Tables I and II). Menopause and physical or psychological illnesses (such as depression) accentuate chronological ageing (2). In addition, extrinsic ageing is mainly related to photo-ageing due to repeated exposure to solar radiation (Table III, Figs 1–5) (2, 3), which may be aggravated by smoking (4, 5). Other factors may eventually affect ageing, such as alcohol intake, drug use (e.g. crack cocaine), or possibly atmospheric pollution (2). Dermatoporosis: an emerging concept “Dermatoporosis” is an emerging clinical condition due to increased life expectancy and ageing of the population. This recent neologism was first proposed by a Swiss dermatologist, Pr Jean-Hilaire Saurat (6), and can be compared to (rheuma- tological) osteoporosis. The term dermatoporosis refers to various manifestations related to chronic fragility of the skin and its consequences. It implies the need to treat, but also to prevent, this age-related condition, as rheumatologists endeavour to do with osteoporosis (6–10). The first manifes- tations of dermatoporosis occur at approximately 60 years of 36 Table I. Morphological changes in normal aged skin, after Fenske & Lober (1) Epidermis ↓ Thickness ↓ Vertical height and ↑ Surface of keratinocytes ↓ Corneocyte adhesion Flattening of the dermal-epidermal junction Duplication of lamina densa and fibrillar anchorage complex ↓ Number of melanocytes ↓ Number of Langerhans cells Dermis ↓ Number of fibroblasts ↓ Number of mast cells ↓ Capillary network Alteration of blood vessels Abnormal nerve endings Adnexal structures ↓ Number of eccrine glands Attenuation of eccrine and apocrine glands Hyperplasia of the sebaceous glands ↓ Number of scalp and facial hair follicles ↓ Hair shaft thickness Hair greying, canitia Nail thinning ↓ Size of the lunula Subcutaneous tissue ↓ Especially in the face, hands, legs and feet ↑ Abdominal belt (man) and thighs (woman) Table II. Clinical correlation of normal skin ageing after Fenske & Lober (1) Pallor and laxity of the skin Hair greying Scalp and beard alopecia Xerosis ↑ Terminal hair follicles: face, ear, nose Nail fragility ↑ Treatment time of onychomycosis Fragility of the skin Purpura and haematomas, vulnerability of subcutaneous tissues ↑ Susceptibility to skin tears and bubbles ↓ Dermatoglyphs ↓ Naevus Irregular pigmentation ↓ Sensation ↓ Ability to make fine gestures ↓ Body odour Benign and malignant skin tumours Forum for Nord Derm Ven 2018, Vol. 23, No. 2