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Many different topical agents and inoffice procedures are used to treat photoaged skin Most of these remedies function by resurfacing the epidermis The goal is to remove the damaged epidermis and, in some instances, dermis, and allow them to be replaced with remodeled skin layers There is some evidence that resurfacing procedures can induce the formation of new collagen with a normal staining pattern in contrast to the basophilic elastotic masses of collagen present in photoaged skin51 Although there are several treatments available for aged skin, prevention is still paramount and should be emphasized to all patients
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1 Unna PG Histopathologie der Hautkrankheiten Berlin, Germany: A Herschwald; 1894 2 Uitto J Understanding premature skin aging N Engl J Med 1997;337:1463 3 Fenske NA, Lober CW Structural and functional changes of normal aging skin J Am Acad Dermatol 1986;15:571
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4 Lovell CR, Smolenski KA, Duance VC, et al Type I and III collagen content and fibre distribution in normal human skin during ageing Br J Dermatol 1987;117: 419 5 Gallagher RP, Rivers JK, Lee TK, et al Broad-spectrum sunscreen use and the development of new nevi in white children: a randomized controlled trial JAMA 2000;283:2955 6 Lavker RM Structural alterations in exposed and unexposed aged skin J Invest Dermatol 1979;73:59 7 Yaar M, Gilchrest B Aging of skin In: Freeberg I, Eisen A Wolff K, et al, eds Fitzpatrick s Dermatology in General Medicine 5th ed New York, NY: McGrawHill; 1999:1697 8 Lock-Andersen J, Therkildsen P, de Fine Olivarius, et al Epidermal thickness, skin pigmentation and constitutive photosensitivity Photodermatol Photoimmunol Photomed 1997;13:153 9 Whitton JT, Everall JD The thickness of the epidermis Br J Dermatol 1973;89: 467 10 Sandby-Moller J, Poulsen T, Wulf HC Epidermal thickness at different body sites: relationship to age, gender, pigmentation, blood content, skin type and smoking habits Acta Derm Venereol 2003;83:410 11 Contet-Audonneau JL, Jeanmaire C, Pauly G A histological study of human wrinkle structures: comparison between sun-exposed areas of the face, with or without wrinkles, and sun-protected areas Br J Dermatol 1999;140:1038 12 Katzberg AA The area of the dermo-epidermal junction in human skin Anat Rec 1985;131:717 13 Kligman AM Perspectives and problems in cutaneous gerontology J Invest Dermatol 1979;73:39 14 Orentreich N, Selmanowitz VJ Levels of biological functions with aging Trans NY Acad Sci 1969;31:992 15 Fisher GJ, Wang ZQ, Datta SC, et al Pathophysiology of premature skin aging induced by ultraviolet light N Engl J Med 1997;337:1419 16 Kligman AM, Zheng P, Lavker RM The anatomy and pathogenesis of wrinkles Br J Dermatol 1985;113:37 17 Gniadecka M, Nielsen OF, Wessel S, et al Water and protein structure in photoaged and chronically aged skin J Invest Dermatol 1998;111:1129 18 Oikarinen A The aging of skin: chronoaging versus photoaging Photo-dermatol Photoimmunol Photomed 1990; 7:3 19 Griffiths CE, Russman AN, Majmudar G, et al Restoration of collagen formation in photodamaged human skin by tretinoin (retinoic acid) New Engl J Med 1993; 329:530 20 Shuster S, Black MM, McVitie E The influence of age and sex on skin thickness, skin collagen and density Br J Dermatol 1975;93:639 21 Craven NM, Watson RE, Jones CJ, et al Clinical features of photodamaged human skin are associated with a reduction in collagen VII Br J Dermatol 1997; 137:344 22 Fisher GJ, Datta SC, Talwar HS, et al Molecular basis of sun-induced premature skin ageing and retinoid antagonism Nature 1996;379:335 23 Rosette C, Karin M Ultraviolet light and osmotic stress: activation of the JNK cas-
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cade through multiple growth factor and cytokine receptors Science 1996;274:1194 Ham J, Babij C, Whitfield J, et al A c-Jun dominant negative mutant protects sympathetic neurons against programmed cell death Neuron 1995;14:927 Xia Z, Dickens M, Raingeaud J, et al Opposing effects of ERK and JNK-p38 MAP kinases on apoptosis Science 1995;270:1326 Chung JH, Kang S, Varani J, et al Decreased extracellular-signal-regulated kinase and increased stress-activated MAP kinase activities in aged human skin in vivo J Invest Dermatol 2000;115: 177 Fisher GJ, Voorhees JJ Molecular mechanisms of retinoid actions in skin FASEB J 1996;10:1002 Chung KY, Agarwal A, Uitto J, et al An AP-1 binding sequence is essential for regulation of the human alpha2(I) collagen (COL1A2) promoter activity by transforming growth factor-beta J Biol Chem 1996;271:3272 Mitchell RE Chronic solar dermatosis: a light and electron microscopic study of the dermis J Invest Dermatol 1967;48: 203 Tsuji T, Hamada T Age-related changes in human dermal elastic fibers Br J Dermatol 1981;105:57 Scharffetter-Kochanek K, Brenneisen P, Wenk J, et al Photoaging of the skin from phenotype to mechanisms Exp Gerontol 2000;35:307 Matsuoka L, Uitto J Alterations in the elastic fibers in cutaneous aging and solar elastosis In: Balin A, Kligman AM, eds Aging and the Skin New York, NY: Raven Press; 1989:141 Lavker RM Cutaneous aging: chronologic versus photoaging In: Gilchrest BA
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Photodamage 1st ed Cambridge, MA: Blackwell Science; 1995:128 Montagna W, Carlisle K Structural changes in aging human skin J Invest Dermatol 1979;73:47 Escoffier C, de Rigal J, Rochefort A, et al Age-related mechanical properties of human skin: an in vivo study J Invest Dermatol 1989;93:353 Ghersetich I, Lotti T, Campanile G, et al Hyaluronic acid in cutaneous intrinsic aging Int J Dermatol 1994;33:119 Pearce RH, Grimmer BJ Age and the chemical constitution of normal human dermis J Invest Dermatol 1972;58:347 Bernstein EF, Underhill CB, Hahn PJ, et al Chronic sun exposure alters both the content and distribution of dermal glycosaminoglycans Br J Dermatol 1996; 135:255 Gilchrest BA, Stoff JS, Soter NA Chronologic aging alters the response to ultraviolet-induced inflammation in human skin J Invest Dermatol 1982; 79:11 Kurimoto I, Streilein JW cis-urocanic acid suppression of contact hypersensitivity induction is mediated via tumor necrosis factor-alpha J Immunol 1992; 148:3072 Kurimoto I, Streilein JW Deleterious effects of cis-urocanic acid and UVB radiation on Langerhans cells and on induction of contact hypersensitivity are mediated by tumor necrosis factor-alpha J Invest Dermatol 1992;99:69S Ross JA, Howie SEM, Norval M, et al Ultraviolet-irradiated urocanic acid suppresses delayed-type hypersensitivity to herpes simplex virus in mice J Invest Dermatol 1986;87:630 de Fine Olivarius F, Wulf HC, Crosby J, et al Isomerization of urocanic acid after
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ultraviolet radiation is influenced by skin pigmentation J Photochem Photobiol B 1999;48:42 Beissert S, Mohammad T, Torri H, et al Regulation of tumor antigen presentation by urocanic acid J Immunol 1997;159:92 De Fine Olivarius F, Lock-Andersen J, Larsen FG, et al Urocanic acid isomers in patients with basal cell carcinoma and cutaneous malignant melanoma Br J Dermatol 1998;138:986 Snellman E, Jansen CT, Rantanen T, et al Epidermal urocanic acid concentration and photoisomerization reactivity in patients with cutaneous malignant melanoma or basal cell carcinoma Acta Derm Venereol 1999;79:200 Leccia MT, Yaar M, Allen N, et al Solar simulated irradiation modulates gene expression and activity of antioxidant enzymes in cultured human dermal fibroblasts Exp Dermatol 2001;10:272 Cui R, Widlund HR, Feige E, et al Central role of p53 in the suntan response and pathologic hyperpigmentation Cell 2007; 128:853 Ghadially R, Brown BE, Sequeira-Martin SM, et al The aged epidermal permeability barrier Structural, functional, and lipid biochemical abnormalities in humans and a senescent murine model J Clin Invest 1995;95:2281 Tezuka T, Qing J, Saheki M, et al Terminal differentiation of facial epidermis of the aged: immunohistochemical studies Dermatology 1994;188:21 Nelson BR, Majmudar G, Griffiths CE, et al Clinical improvement following dermabrasion of photoaged skin correlates with synthesis of collagen I Arch Dermatol 1994;130:1136
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