Skin aging (overview) L98.8

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Age skin; Aging of the skin; Aging process of the skin; Endogenous skin ageing; Environmental Ageing; Exogenous ageing; Extrinsic skin aging; Intrinsic skin aging; Light aging; Presbyoderma

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The skin aging process is essentially composed of 2 processes:

  • Biological or endogenous ageing (ageing) also intrinsic skin ageing
  • environmental ageing or exogenous ageing (especially light ageing) also extrinsic skin ageing

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Polyätiological endogenously and exogenously induced process. To be discussed:

  • Metabolic changes (such as the irreversible accumulation of Advanced Glycation Endproducts - AGEs). AGEs are bioactive molecules that can serve as a strong and independent predictor of atherosclerosis and cardiovascular mortality in diabetics and hemodialysis patients.
  • UV-induced inflammatory reactions, such as those initiated by the activated acrylic hydrocarbon receptor.
  • Genetic alterations (dysregulation of the insulin and STAT3 signaling pathway; upregulation of proaptotic genes, alteration of cytoskeletal genes such as keratin 2A, 6A, and 16A).
  • Free radical damage (especially membrane damage due to lipid peroxidation). Origin of free radicals (see below oxidative stress): endogenous from mitochondrial respiration, enzymatic reactions (oxidases), arachidonic acid metabolism, phagocytosis processes or exogenous by food, drugs, environmental toxins, UV light.
  • Alteration of the Wnt signaling pathway (regulated by various processes in embryonic development and can lead to tumour formation) is suppressed both on RNA and protein level.
  • Influences of reduced hormone levels.

Investigations on best. Progeria syndromes show that best. important biological processes such as DNA replication, recombination, repair and transcription - as well as mitochondrial functions, cell cycle and apoptosis play an important role in skin ageing.

Furthermore, the skin ageing process is negatively influenced by infrared irradiation, nicotine abuse or environmental pollution (e.g. fine dust pollution).

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Entire skin organ with predilection in the area of the light-exposed areas.

Clinical features
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Frequent histological manifestations of skin aging:
Dermal structure Aged skin Light aged skin
Epidermis diluted, no atypias acanthosis, cell atypia
Papillary dermis thin boundary zone thickened border zone, actin. Elastosis
Reticular dermis diluted, fewer fibroblasts with low activity, fewer mast cells thickened, elastosis, increased fibroblasts, with increased activity, mast cell proliferation
Collagen fibers reduced, increase in cross-linking with compression, disordered bundles degenerative changes and reduction
Elastic fibres normal to slightly reduced considerable tissue proliferation, degeneration
Dermal vessels moderately diminished considerably reduced, telangiectasia

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Typical clinical picture. Based on skin aging scores, if necessary. Histology.

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  • Combinations of various therapies are possible and useful.
  • Prophylaxis through antioxidants systemically (vitamin A, beta-carotene, vitamin E, vitamin C) or locally, skin care, sun protection, avoidance of nicotine and excessive UV exposure.
  • Tretinoin and isotretinoin creams, chemical peeling with peeling substances such as salicylic acid, trichloroacetic acid or fruit acids (AHS).

Operative therapie
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If necessary, cryosurgery, dermabrasion, laser therapy, bleaching, connective tissue replacement (hyaluronic acid, fibrel, autologous fatty tissue, biological or alloplastic transplants; silicone is obsolete) On the face: face lift, blepharoplasty, brow lifting.

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  1. Kusserow A et al (2005) Unexpected complexity of the Wnt gene family in a sea anemone. Nature 433:156-160.
  2. Makrantonaki E (2015) Skin aging. Dermatologist 66: 730-737
  3. Si Tao et al (2015) Wnt activity and basal niche position sensitize intestinal stem and progenitor cells to DNA damage. EMBO J doi: 10.15252/embj.201490700.
  4. Spanjer AI et al (2016): TGF-β-induced profibrotic signaling is regulated in part by the WNT receptor Frizzled-8 FASEB Journal doi: 10.1096/fj.201500129
  5. Uribarri J et al(2007): Circulating glycotoxins and dietary advanced glycation endproducts: two links to inflammatory response, oxidative stress, and aging. J Gerontol A Biol Sci Med Sci 62: 427-433.
  6. Vierkötter A et al (2010) Airborne particle exposure and extrinsic skin aging. J Invest Dermatol 130:2719-2726.


Please ask your physician for a reliable diagnosis. This website is only meant as a reference.


Last updated on: 29.10.2020