WRINKLED SKIN in .NET

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CHAPTER 19 WRINKLED SKIN
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Aging is a process that occurs in all organs, but is most visible in the skin The skin may very well reflect or act as an outward sign of processes occurring in the internal organs In fact, the amount of facial wrinkling has been shown to correlate with the extent of lung disease in COPD2 The naturallyoccurring functional decline of organs with age can be exacerbated by environmental factors, but there is certainly a genetic component that influences the aging process Little is known at this point about the genetics of skin aging except for the genes that have been implicated in premature aging syndromes such as Werner s syndrome3 (Table 19-1) Mammalian cells can undergo only a certain number of cell divisions before replicative senescence occurs and they are no longer able to divide6 This may be nature s way of preventing these cells from becoming cancerous; however, this process plays a role in aging as well
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TTAGGG Telomeric DNA repeats 5 A Telomere Overhang concealed 3 Telomere DNA G rich strand
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lagen and elastin as well as other vital skin components The role of cytokines in aging has not been completely elucidated, but this will likely be an area of extreme interest in upcoming research The function of antigen-presenting cells, T cells, and B cells declines with age These changes are thought to contribute to the higher risk of infections and cancer observed in older patients17
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B Telomere Overhang exposed
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The endocrine system may contribute to aging It is likely that insulin, vitamin D, and thyroid hormone levels influence skin aging in ways that have not yet been elucidated Hormones, especially estrogen and androgens, are significant factors in the aging of skin (see 5)
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COSMETIC DERMATOLOGY: PRINCIPLES AND PRACTICE
FIGURE 19-1 A Telomeres in normal loop con guration The 3-prime end is held in place by the last 150 to 200 base pairs on the 3-prime strand B Once damaged, the loop structure opens and the 3-prime end is exposed (Adapted from page 965 Fitzpatrick s 7th edition) bonding together of thymine dimers, which may lead to disruption of the telomere loop (Fig 19-2) This is one way to explain the overlap seen in intrinsic and extrinsic aging
PREVENTION AND TREATMENT
Identifying skin types predisposed to wrinkling is the first step in patient management The Baumann Skin Typing System ( 9) is a useful classification approach, aiding physicians and patients to understand and manage their skin needs to prevent and treat wrinkles Other classification systems, such as those by Lemprele and Glogau (see 40), also help physicians quantify the amount of wrinkling After assessing the degree of wrinkling, patient education is the next essential step Patients must understand that prevention of additional wrinkling is the mainstay of managing wrinkled skin Effects of certain behaviors such as excessive sun exposure and smoking should be discussed, and treatment plans with expected and realistic results should be explained in detail with patients It is well known that sunscreen and sun avoidance are key elements in preventing extrinsic photoaging Although UVA is more often implicated in cutaneous aging, coverage for both UVA and UVB is recommended when selecting a sunscreen A routine skin regimen containing retinoid application is also valuable in both the prevention and treatment of aging skin Topical retinoids have been shown to both increase collagen synthesis18 and decrease the MMPs involved in collagen and elastin degradation19 Since oxidative stress resulting from UV irradiation and free radicals are implicated in skin aging, antioxidants have an important role in the prevention and treatment of wrinkles (see 34) Of antioxidants, vitamin C (ascorbic acid) deserves special
Immune System
Aging is associated with an increase in proinflammatory cytokines (see 4) These cytokines result in inflammation, which plays a role in degrading col-
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