Forum for Nordic Dermato-Venereology Nr 2, 2018 | Page 9

Nicolas Kluger – Skin ageing and dermatoporosis
source of healthcare costs and hospitalization. It is important
that caregivers can recognize this pathology in order to avoid
unnecessary, or even harmful, explorations and therapies.
In addition, new local topical treatments should emerge in
the future for the management of dermatoporosis and, more
generally in cosmetology, for cutaneous atrophy induced by
ageing and/or corticosteroid therapy (15, 19).
References
Fig. 7. Extensive spontaneous hematomas of the lower limbs in a patient
with low levels of vitamin C (13).
bled through the education of nursing staff, protection of the
lower limbs, adaptation of furniture at home and in public
places, correction of visual disorders, etc. On the other hand,
topical treatments including intermediate-sized fragments
of hyaluronic acid (ranging from 50,000 to 400,000 Da, but
not smaller or larger) could correct the cutaneous atrophy of
dermatoporosis induced by age or local corticosteroid therapy
through a dependent CD44 mechanism (15). In addition, a
synergistic action has recently been shown in mice in vitro
and in vivo, but also in patients with dermatoporosis, when
applying retinaldehyde and fragments of hyaluronic acid of
intermediate size (16, 17). Recently, Humbert et al. (18) showed
that the application of a 5% vitamin C topical ointment twice
daily for 12 weeks was efficient in the treatment of Bateman’s
purpura: it corrected the purpura and increased dermal thick-
ness. Vitamin C deficiency may play a role in the pathogenesis
of senile purpura and may be related to local scurvy (18).
With increasing life expectancy and an ageing population,
dermatoporosis could become a public health problem, a
Table IV. Different stages of dermatoporosis according to Kaya
& Saurat (8)
Stage I
Stage II
Stage III
Stage IV
Extreme skin atrophy, purpura, stellate pseudoscars
Stage 1 lesions and some skin lacerations due to minor
trauma
Numerous and large cutaneous lacerations with a notable
delay of wound healing
Deep dissecting haematoma (s) associated with any
lesion of another stage, which may result in skin necrosis
Forum for Nord Derm Ven 2018, Vol. 23, No. 2
1. Fenske NA, Lober CW. Structural and functional changes of normal
aging skin. J Am Acad Dermatol 1986; 15: 571–585.
2. Beylot C. Skin aging: clinicopathological features and mechanisms.
Ann Dermatol Venereol 2009; 136 Suppl 6: S263–S269.
3. Gilchrest BA. Skin aging and photoaging: an overview. J Am Acad
De rmatol 1989; 21: 610–613.
4. Biver-Dalle C, Humbert P. Tobacco and skin. Ann Dermatol Ve-
nereol 2010; 137: 568–572; quiz 67.
5. Ortiz A, Grando SA. Smoking and the skin. Int J Dermatol 2012;
51: 250–262.
6. Saurat JH. Quand la peau devient insuffisante. Méd Hyg 2004;
2472: 476.
7. Saurat JH. Dermatoporosis. The functional side of skin aging.
Dermatology 2007; 215: 271–272.
8. Kaya G, Saurat JH. Dermatoporosis: a chronic cutaneous insuffi-
ciency/fragility syndrome. Clinicopathological features, mecha-
nisms, prevention and potential treatments. Dermatology 2007;
215: 284–294.
9. Kaya G, Jacobs F, Prins C, Viero D, Kaya A, Saurat JH. Deep dissect-
ing hematoma: an emerging severe complication of dermatoporo-
sis. Arch Dermatol 2008; 144: 1303–1308.
10. Saurat JH. Dermatoporosis of the hand and upper limb: skin aging
is a disease. 3rd Mega Hand International Symposium (Paris, 19–20
Mars 2010). Oral communication.
11. Mengeaud V, Dautezac-Vieu C, Josse G, Vellas B, Schmitt AM. Prev-
alence of dermatoporosis in elderly French hospital in-patients: a
cross-sectional study. Br J Dermatol 2012; 166: 442–443.
12. Saurat JH, Mengeaud V, Georgescu V, Coutanceau C, Ezzedine K,
Taieb C. A simple self-diagnosis tool to assess the prevalence of
dermatoporosis in France. J Eur Acad Dermatol Venereol 2017;
31: 1380–1386.
13. Kluger N, Schaan K, Girard C, Guillot B, Dereure O. Hématomes
multiples sur dermatoporose et carence en vitamine C. Nouv
Dermatol 2010; 29: 371–373.
14. Kluger N. Bullous hematomas as an indicator of dermatoporosis.
Neurol Psychiatr Geriatr 2016; 16: 123–126.
15. Kaya G, Tran C, Sorg O, Hotz R, Grand D, Carraux P, et al. Hy-
aluronate fragments reverse skin atrophy by a CD44-dependent
mechanism. PLoS Med 2006; 3: e493.
16. Barnes L, Tran C, Sorg O, Hotz R, Grand D, Carraux P, et al. Syn-
ergistic effect of hyaluronate fragments in retinaldehyde-induced
skin hyperplasia which is a Cd44-dependent phenomenon. PLoS
One 2010; 5: e14372.
17. Nikolic DS, Ziori C, Kostaki M, Kostaki M, Fontao L, Saurat JH, et
al. Hyalurosome gene regulation and dose-dependent restoration
of skin atrophy by retinaldehyde and defined-size hyaluronate
fragments in dermatoporosis. Dermatology 2014; 229: 110–115.
18. Humbert P, Fanian F, Lihoreau T, Jeudy A, Pierard GE. Bateman
purpura (dermatoporosis): a localized scurvy treated by topical
vitamin C – double-blind randomized placebo-controlled clinical
trial. J Eur Acad Dermatol Venereol 2018; 32: 323–328.
19. Kaya G. New therapeutic targets in dermatoporosis. J Nutr Health
Aging 2012; 16: 285–288.
E ducational R eview
39