Forum for Nordic Dermato-Venereology Nr 2, 2018 | Page 8

Nicolas Kluger – Skin ageing and dermatoporosis
Fig. 4. Idiopathic guttate hypomelanosis of the limbs (Costa, 1951). Fig. 5. Cutis rhomboidalis nuchae (Jadassohn, 1925).
The functional consequences of this cutaneous fragility are the
development of cutaneous lacerations, delayed wound healing
and deep dissecting haematomas between the subcutaneous fat
and the muscular fascia, which can lead to large areas of necrosis
due to vascular ischaemia (Fig. 7) (9). Of note, Saurat et al. (12).
developed a 14-item questionnaire for evaluating dermatoporosis
in adults, which is relatively easy to perform C deficiency is responsible for purpura and haematoma, and
Four stages of dermatoporosis were defined by Kaya & Saurat in
2007 (8) (Table IV). In a study by Mengeaud et al. (11), 82–92%
of patients had stage 1 lesions, 80–14% stage 2 lesions, and
4% stage 3 lesions. No patient presented with deep dissecting
stage 4 haematomas (9).
Local or systemic corticosteroids are considered an aggravating
factor in dermatoporosis (8). However, Mengeaud et al. did
not find such correlation in their study, but instead found a
significant association between dermatoporosis and severe
chronic renal failure (11). Long-term anticoagulation can pro-
mote the development of dissecting haematomas and various
co-morbidities (diabetes, arteriovenous insufficiency of limbs,
polyneuropathies) contribute to delayed healing (9). Finally,
vitamin C deficiency must not be neglected. Indeed, vitamin
elderly people are at risk of vitamin C deficiency. Vitamin C
deficiency may be an aggravating factor in dermatoporosis,
as we have observed (Fig. 7) (13).
Histologically, dermatoporosis is characterized by a cutaneous
atrophy affecting all skin components. There is a striking
decrease in hyaluronic acid in the extracellular matrix of the
dermis, affecting the viscoelasticity of the skin (14). Amyloido-
sis is ruled out by negative specific staining, such as Congo red.
Dermatoporosis is primarily a consequence of ageing and
prolonged sun exposure, but some genetic factors may be
relevant (8). It is linked to a progressive alteration of the
extracellular matrix of the dermis and, in particular, of its
major component, hyaluronic acid and its cellular receptor,
CD44 (8). Indeed, hyaluronic acid is an active molecule that
induces intracellular signalling after binding to the CD44
membrane receptor. Activation of CD44 regulates keratinocyte
proliferation and controls the homeostasis of hyaluronic acid.
Care involves prevention of minimal trauma, which can be
responsible for major bruising in elderly people. This is ena-
Fig. 6. Exemples of dermatoporosis presentions. A) Bateman senile purpura (Bateman, 1818) and pseudoscars of the hands. B) Marked cutaneous atro-
phy, senile purpura and pseudoscars of the forearms. C) Extensive dermatoporosis of the décolleté and right upper limb with purpura, pigmentation,
pseudoscars and cutaneous lacerations.
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E ducational R eview
Forum for Nord Derm Ven 2018, Vol. 23, No. 2